   A1001007Dressing for one wound                                                          Dressing for one wound                                                                                                                    C                                     02002070120020701        N
   A2001007Dressing for two wounds                                                         Dressing for two wounds                                                                                                                   C                                     02002070120020701        N
   A3001007Dressing for three wounds                                                       Dressing for three wounds                                                                                                                 C                                     02002070120020701        N
   A4001007Dressing for four wounds                                                        Dressing for four wounds                                                                                                                  C                                     02002070120020701        N
   A5001007Dressing for five wounds                                                        Dressing for five wounds                                                                                                                  C                                     02002070120020701        N
   A6001007Dressing for six wounds                                                         Dressing for six wounds                                                                                                                   C                                     02002070120020701        N
   A7001007Dressing for seven wounds                                                       Dressing for seven wounds                                                                                                                 C                                     02002070120020701        N
   A8001007Dressing for eight wounds                                                       Dressing for eight wounds                                                                                                                 C                                     02002070120020701        N
   A9001007Dressing for nine or more wounds                                                Dressing for 9 or more wound                                                                                                              C                                     02002070120020701        N
   AA001007Anesthesia services performed personally by anesthesiologist                    Anesthesia perf by anesgst                             3350.5                                                                             D                                     01984010120010101        N
   AD001007Medical supervision by a physician: more than four concurrent anesthesia        MD supervision, >4 anes proc                           3350.5                                                                             D                                     01984010120010101        N
   AD002008procedures
   AE001007Registered dietician                                                            Registered dietician                                                                                                                      C                                     02005010120050101        N
   AF001007Specialty physician                                                             Specialty physician                                                                                                                       C                                     02005010120050101        N
   AG001007Primary physician                                                               Primary physician                                                                                                                         C                                     02005010120050101        N
   AH001007Clinical psychologist                                                           Clinical psychologist                                  2150    5112                                                                       D                                     01991010119970101        N
   AI001007Principal physician of record                                                   Principal physician of rec                                                                                                                C                                     02010010120100101        N
   AJ001007Clinical social worker                                                          Clinical social worker                                 2152    5113                                                                       D                                     01991010119970101        N
   AK001007Non participating physician                                                     Non participating physician                                                                                                               C                                     02005010120050101        N
   AM001007Physician, team member service                                                  Physician, team member svc                             4105.7                                                       QM                    D                      0069           01991010119970101        N
   AP001007Determination of refractive state was not performed in the course of diagnostic No dtmn of refractive state                                                                                                               C                                     01984010119970101        N
   AP002008ophthalmological examination
   AQ001007Physician providing a service in an unlisted health professional shortage area  Physician service HPSA area                                                                                                               C                                     02006010120060101        N
   AQ002008(hpsa)
   AR001007Physician provider services in a physician scarcity area                        Physician scarcity area                                                                                                                   C                                     02005010120050101        N
   AS001007Physician assistant, nurse practitioner, or clinical nurse specialist services  Assistant at surgery service                                                                                                              C                      0069           01988010119990101        N
   AS002008for assistant at surgery
   AT001007Acute treatment (this modifier should be used when reporting service 98940,     Acute treatment                                                                                                                           C                                     01984010119980101        N
   AT00200898941, 98942)
   AU001007Item furnished in conjunction with a urological, ostomy, or tracheostomy supply Uro, ostomy or trach item                                                                                                                 C                                     02003010120030101        N
   AV001007Item furnished in conjunction with a prosthetic device, prosthetic or orthotic  Item w prosthetic/orthotic                                                                                                                C                                     02003010120030101        N
   AW001007Item furnished in conjunction with a surgical dressing                          Item w a surgical dressing                                                                                                                C                                     02003010120030101        N
   AX001007Item furnished in conjunction with dialysis services                            Item w dialysis services                                                                                                                  C                      0000           02003010120030101        N
   AY001007Item or service furnished to an esrd patient that is not for the treatment of   Item/service not for ESRD tx                                                                                                              C                                     02011010120110101        N
   AY002008esrd
   AZ001007Physician providing a service in a dental health professional shortage area for Physician serv in dent HPSA                                                                                                               I                                     02011010120110101        N
   AZ002008the purpose of an electronic health record incentive payment
   BA001007Item furnished in conjunction with parenteral enteral nutrition (pen) services  Item w pen services                                                                                                                       C                                     02003010120030101        N
   BL001007Special acquisition of blood and blood products                                 Spec acquisition blood prods                                                                                                              C                                     02005070120050701        N
   BO001007Orally administered nutrition, not by feeding tube                              Nutrition oral admin no tube                                                                                                              C                                     02003010120030101        N
   BP001007The beneficiary has been informed of the purchase and rental options and has    Bene electd to purchase item                                                                                                              C                                     01992010119970101        N
   BP002008elected to purchase the item
   BR001007The beneficiary has been informed of the purchase and rental options and has    Bene elected to rent item                                                                                                                 C                                     01992010119970101        N
   BR002008elected to rent the item
   BU001007The beneficiary has been informed of the purchase and rental options and after  Bene undecided on purch/rent                                                                                                              C                                     01992010119970101        N
   BU00200830 days has not informed the supplier of his/her decision
   CA001007Procedure payable only in the inpatient setting when performed emergently on an Procedure payable inpatient                                                                                                               C                                     02003010120030101        N
   CA002008outpatient who expires prior to admission
   CB001007Service ordered by a renal dialysis facility (rdf) physician as part of the     ESRD bene part a snf-sep pay                                                                                                              C                                     02003040120040101        N
   CB002008esrd beneficiary's dialysis benefit, is not part of the composite rate, and is
   CB003008separately reimbursable
   CC001007Procedure code change (use 'cc' when the procedure code submitted was changed   Procedure code change                                                                                                                     C                                     01990010119970101        N
   CC002008either for administrative reasons or because an incorrect code was filed)
   CD001007Amcc test has been ordered by an esrd facility or mcp physician that is part of AMCC test for ESRD or MCP MD                           4270.2                                                                             D                                     02004010120040101        N
   CD002008the composite rate and is not separately billable
   CE001007Amcc test has been ordered by an esrd facility or mcp physician that is a       Med neces AMCC tst sep reimb                           4270.2                                                                             D                                     02004010120040101        N
   CE002008composite rate test but is beyond the normal frequency covered under the rate
   CE003008and is separately reimbursable based on medical necessity
   CF001007Amcc test has been ordered by an esrd facility or mcp physician that is not     AMCC tst not composite rate                            4270.2                                                                             D                                     02004010120040101        N
   CF002008part of the composite rate and is separately billable
   CG001007Policy criteria applied                                                         Policy criteria applied                                                                                                                   C                                     02008070120080701        N
   CH0010070 percent impaired, limited or restricted                                       0 percent impaired, ltd, res                                                                                                              D                      0180           02013010120130101        A
   CI001007At least 1 percent but less than 20 percent impaired, limited or restricted     1 to <20 percent impaired                                                                                                                 D                      0180           02013010120130101        A
   CJ001007At least 20 percent but less than 40 percent impaired, limited or restricted    20 to <40 percent impaired                                                                                                                D                      0180           02013010120130101        A
   CK001007At least 40 percent but less than 60 percent impaired, limited or restricted    40 to <60 percent impaired                                                                                                                D                      0180           02013010120130101        A
   CL001007At least 60 percent but less than 80 percent impaired, limited or restricted    60 to <80 percent impaired                                                                                                                D                      0180           02013010120130101        A
   CM001007At least 80 percent but less than 100 percent impaired, limited or restricted   80 to <100 percent impaired                                                                                                               D                      0180           02013010120130101        A
   CN001007100 percent impaired, limited or restricted                                     100 percent impaired, ltd                                                                                                                 D                      0180           02013010120130101        A
   CR001007Catastrophe/disaster related                                                    Catastrophe/disaster related                                                                                                              C                                     02005082120050821        N
   CS001007Item or service related, in whole or in part, to an illness, injury, or         Gulf Oil 2010 Spill Related                                                                                                               C                                     02011010120110101        N
   CS002008condition that was caused by or exacerbated by the effects, direct or indirect,
   CS003008of the 2010 oil spill in the gulf of mexico, including but not limited to
   CS004008subsequent clean-up activities
   E1001007Upper left, eyelid                                                              Upper left eyelid                                                                                                                         C                                     01995010119990101        N
   E2001007Lower left, eyelid                                                              Lower left eyelid                                                                                                                         C                                     01995010119990101        N
   E3001007Upper right, eyelid                                                             Upper right eyelid                                                                                                                        C                                     01995010119990101        N
   E4001007Lower right, eyelid                                                             Lower right eyelid                                                                                                                        C                                     01995010119990101        N
   EA001007Erythropoetic stimulating agent (esa) administered to treat anemia due to       ESA, anemia, chemo-induced                                                                                                                D                      0147           02008010120080101        N
   EA002008anti-cancer chemotherapy
   EB001007Erythropoetic stimulating agent (esa) administered to treat anemia due to       ESA, anemia, radio-induced                                                                                                                D                      0147           02008010120080101        N
   EB002008anti-cancer radiotherapy
   EC001007Erythropoetic stimulating agent (esa) administered to treat anemia not due to   ESA, anemia, non-chemo/radio                                                                                                              D                      0147           02008010120080101        N
   EC002008anti-cancer radiotherapy or anti-cancer chemotherapy
   ED001007Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13. 0 g/dl) HCT>39% or Hgb>13g>=3 cycle                                                                                                               D                      0145           02008010120080101        N
   ED002008for 3 or more consecutive billing cycles immediately prior to and including the
   ED003008current cycle
   EE001007Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13. HCT>39% or Hgb>13g<3 cycle                                                                                                                D                      0145           02008010120080101        N
   EE0020080 g/dl) for 3 or more consecutive billing cycles immediately prior to and
   EE003008including the current cycle
   EJ001007Subsequent claims for a defined course of therapy, e. G. , epo, sodium          Subsequent claim                                       4273.2                                                                             D                                     01991010120000101        N
   EJ002008hyaluronate, infliximab
   EM001007Emergency reserve supply (for esrd benefit only)                                Emer reserve supply (ESRD)                             3045.7                                                                             D                                     01991010119970101        N
   EP001007Service provided as part of medicaid early periodic screening diagnosis and     Medicaid EPSDT program svc                                                                                                                C                                     01987010119970101        N
   EP002008treatment (epsdt) program
   ET001007Emergency services                                                              Emergency Services                                                                                                                        C                                     01984010120020101        N
   EY001007No physician or other licensed health care provider order for this item or      No md order for item/service                                                                                                              C                                     02003010120030101        N
   EY002008service
   F1001007Left hand, second digit                                                         Left hand, second digit                                                                                                                   C                                     01995010119990101        N
   F2001007Left hand, third digit                                                          Left hand, third digit                                                                                                                    C                                     01995010119990101        N
   F3001007Left hand, fourth digit                                                         Left hand, fourth digit                                                                                                                   C                                     01995010119990101        N
   F4001007Left hand, fifth digit                                                          Left hand, fifth digit                                                                                                                    C                                     01995010119990101        N
   F5001007Right hand, thumb                                                               Right hand, thumb                                                                                                                         C                                     01995010119990101        N
   F6001007Right hand, second digit                                                        Right hand, second digit                                                                                                                  C                                     01995010119990101        N
   F7001007Right hand, third digit                                                         Right hand, third digit                                                                                                                   C                                     01995010119990101        N
   F8001007Right hand, fourth digit                                                        Right hand, fourth digit                                                                                                                  C                                     01995010119990101        N
   F9001007Right hand, fifth digit                                                         Right hand, fifth digit                                                                                                                   C                                     01995010119990101        N
   FA001007Left hand, thumb                                                                Left hand, thumb                                                                                                                          C                                     01995010119990101        N
   FB001007Item provided without cost to provider, supplier or practitioner, or full       Item provided without cost                                                                                                                I                                     02006010120080101        N
   FB002008credit received for replaced device (examples, but not limited to, covered
   FB003008under warranty, replaced due to defect, free samples)
   FC001007Partial credit received for replaced device                                     Part credit, replaced device                                                                                                              D                      0143           02008010120080101        N
   FP001007Service provided as part of family planning program                             Svc part of family plan pgm                                                                                                               C                                     01987010120050101        N
   G1001007Most recent urr reading of less than 60                                         URR reading of less than 60                                                                                                               C                                     01997010119980101        N
   G2001007Most recent urr reading of 60 to 64. 9                                           URR reading of 60 to 64.9                                                                                                                C                                     01997010119980101        N
   G3001007Most recent urr reading of 65 to 69. 9                                          URR  reading of 65 to 69.9                                                                                                                C                                     01997010119980101        N
   G4001007Most recent urr reading of 70 to 74. 9                                          URR reading of 70 to 74.9                                                                                                                 C                                     01997010119970101        N
   G5001007Most recent urr reading of 75 or greater                                        URR reading of 75 or greater                                                                                                              C                                     01997010119980101        N
   G6001007Esrd patient for whom less than six dialysis sessions have been provided in a   ESRD patient <6 dialysis/mth                                                                                                              C                                     01998050119980501        N
   G6002008month
   G7001007Pregnancy resulted from rape or incest or pregnancy certified by physician as   Payment limits do not apply          35-99             2005.1                                                                             D                      0084           01999070119990701        N
   G7002008life threatening
   G8001007Monitored anesthesia care (mac) for deep complex, complicated, or markedly      Monitored anesthesia care                                                                                                                 C                      0083           01999070119990701        N
   G8002008invasive surgical procedure
   G9001007Monitored anesthesia care for patient who has history of severe                 MAC for at risk patient                                                                                                                   C                                     01999070119990701        N
   G9002008cardio-pulmonary condition
   GA001007Waiver of liability statement issued as required by payer policy, individual    Liability waiver ind case                                                                                                                 C                                     01995010120110101        N
   GA002008case
   GB001007Claim being re-submitted for payment because it is no longer covered under a    Claim resubmitted                                                                                                                         C                                     02002010120020101        N
   GB002008global payment demonstration
   GC001007This service has been performed in part by a resident under the direction of a  Resident/teaching phys serv                            3350.5  4116                                                                       D                                     01997010120010101        N
   GC002008teaching physician
   GD001007Units of service exceeds medically unlikely edit value and represents           Unit of service > MUE value                                                                                                               C                                     02008010120080101        N
   GD002008reasonable and necessary services
   GE001007This service has been performed by a resident without the presence of a         Resident prim care exception                           4116                                                                               D                                     01997010119970101        N
   GE002008teaching physician under the primary care exception
   GF001007Non-physician (e. G. Nurse practitioner (np), certified registered nurse        Nonphysician serv c a hosp                                                                                                                C                                     02003040120030401        N
   GF002008anesthetist (crna), certified registered nurse (crn), clinical nurse specialist
   GF003008(cns), physician assistant (pa)) services in a critical access hospital
   GG001007Performance and payment of a screening mammogram and diagnostic mammogram on    Payment screen mam + diagmam                                                                                                              C                                     02002010120020101        N
   GG002008the same patient, same day
   GH001007Diagnostic mammogram converted from screening mammogram on same day             Diag mammo to screening mamo                                                                                                              C                                     01998100119981001        N
   GJ001007"opt out" physician or practitioner emergency or urgent service                 Opt out provider of er srvc                                                                                                               C                                     01998100119981001        N
   GK001007Reasonable and necessary item/service associated with a ga or gz modifier       Actual item/service ordered                                                                                                               C                                     02002010120080101        N
   GL001007Medically unnecessary upgrade provided instead of non-upgraded item, no charge, Upgraded item, no charge                                                                                                                  C                                     02002010120080101        N
   GL002008no advance beneficiary notice (abn)
   GM001007Multiple patients on one ambulance trip                                         Multiple transports                                                                                                                       C                                     02002010120020101        N
   GN001007Services delivered under an outpatient speech language pathology plan of care   OP speech language service                                                                                                                C                                     01999010120030101        N
   GO001007Services delivered under an outpatient occupational therapy plan of care        OP occupational therapy serv                                                                                                              C                                     01999010120030101        N
   GP001007Services delivered under an outpatient physical therapy plan of care            OP PT services                                                                                                                            C                                     01999010120030101        N
   GQ001007Via asynchronous telecommunications system                                      Telehealth store and forward                                                                                                              C                                     02001100120011001        N
   GR001007This service was performed in whole or in part by a resident in a department of Service by va resident                                                                                                                    C                                     02006010120060101        N
   GR002008veterans affairs medical center or clinic, supervised in accordance with va
   GR003008policy
   GS001007Dosage of erythropoietin stimulating agent has been reduced and maintained in   Epo/darbepoietin reduced 25%                           4273.1                                                                             D                                     02006010120130101        C
   GS002008response to hematocrit or hemoglobin level
   GT001007Via interactive audio and video telecommunication systems                       InteractiveTelecommunication                                                                                                              D                      0073           01999010119990101        N
   GU001007Waiver of liability statement issued as required by payer policy, routine noticeLiability waiver rout notice                                                                                                              C                                     02011010120110101        N
   GV001007Attending physician not employed or paid under arrangement by the patient's     Attending phys not hospice                             4175-5                                                                             D                                     02002010120020101        N
   GV002008hospice provider
   GW001007Service not related to the hospice patient's terminal condition                 Service unrelated to term co                           4175-5                                                                             D                                     02002010120020101        N
   GX001007Notice of liability issued, voluntary under payer policy                        Voluntary liability notice                                                                                                                C                                     02010040120100401        N
   GY001007Item or service statutorily excluded, does not meet the definition of any       Statutorily excluded                                                                                                                      S                                     02002010120070701        N
   GY002008medicare benefit or, for non-medicare insurers, is not a contract benefit
   GZ001007Item or service expected to be denied as not reasonable and necessary           Not reasonable and necessary                           2000                                                                               M                                     02002010120020101        N
   H9001007Court-ordered                                                                   Court-ordered                                                                                                                             I                                     02003010120030101        N
   HA001007Child/adolescent program                                                        Child/adolescent program                                                                                                                  I                                     02003010120030101        N
   HB001007Adult program, non geriatric                                                    Adult program non-geriatric                                                                                                               I                                     02003010120030101        N
   HC001007Adult program, geriatric                                                        Adult program geriatric                                                                                                                   I                                     02003010120030101        N
   HD001007Pregnant/parenting women's program                                              Pregnant/parenting program                                                                                                                I                                     02003010120030101        N
   HE001007Mental health program                                                           Mental health program                                                                                                                     I                                     02003010120030101        N
   HF001007Substance abuse program                                                         Substance abuse program                                                                                                                   I                                     02003010120030101        N
   HG001007Opioid addiction treatment program                                              Opioid addiction tx program                                                                                                               I                                     02003010120030101        N
   HH001007Integrated mental health/substance abuse program                                Mental hlth/substance abs pr                                                                                                              I                                     02003010120030101        N
   HI001007Integrated mental health and mental retardation/developmental disabilities      M hlth/m retrdtn/dev dis pro                                                                                                              I                                     02003010120030101        N
   HI002008program
   HJ001007Employee assistance program                                                     Employee assistance program                                                                                                               I                                     02003010120030101        N
   HK001007Specialized mental health programs for high-risk populations                    Spec hgh rsk mntl hlth pop p                                                                                                              I                                     02003010120030101        N
   HL001007Intern                                                                          intern                                                                                                                                    I                                     02003010120030101        N
   HM001007Less than bachelor degree level                                                 Less than bachelor degree lv                                                                                                              I                                     02003010120030101        N
   HN001007Bachelors degree level                                                          Bachelors degree level                                                                                                                    I                                     02003010120030101        N
   HO001007Masters degree level                                                            Masters degree level                                                                                                                      I                                     02003010120030101        N
   HP001007Doctoral level                                                                  Doctoral level                                                                                                                            I                                     02003010120030101        N
   HQ001007Group setting                                                                   Group setting                                                                                                                             I                                     02003010120030101        N
   HR001007Family/couple with client present                                               Family/couple w client prsnt                                                                                                              I                                     02003010120030101        N
   HS001007Family/couple without client present                                            Family/couple w/o client prs                                                                                                              I                                     02003010120030101        N
   HT001007Multi-disciplinary team                                                         Multi-disciplinary team                                                                                                                   I                                     02003010120030101        N
   HU001007Funded by child welfare agency                                                  Child welfare agency funded                                                                                                               I                                     02003010120030101        N
   HV001007Funded state addictions agency                                                  Funded state addiction agncy                                                                                                              I                                     02003010120030101        N
   HW001007Funded by state mental health agency                                            State mntl hlth agncy funded                                                                                                              I                                     02003010120030101        N
   HX001007Funded by county/local agency                                                   County/local agency funded                                                                                                                I                                     02003010120030101        N
   HY001007Funded by juvenile justice agency                                               Funded by juvenile justice                                                                                                                I                                     02003010120030101        N
   HZ001007Funded by criminal justice agency                                               Criminal justice agncy fund                                                                                                               I                                     02003010120030101        N
   J1001007Competitive acquisition program no-pay submission for a prescription number     CAP no-pay for prescript num                                                                                                              C                                     02006010120060101        N
   J2001007Competitive acquisition program, restocking of emergency drugs after emergency  CAP restock of emerg drugs                                                                                                                C                                     02006010120060101        N
   J2002008administration
   J3001007Competitive acquisition program (cap), drug not available through cap as        CAP drug unavail thru cap                                                                                                                 C                                     02006010120060101        N
   J3002008written, reimbursed under average sales price methodology
   J4001007Dmepos item subject to dmepos competitive bidding program that is furnished by  DMEPOS comp bid furn by hosp                                                                                                              C                                     02010010120100101        N
   J4002008a hospital upon discharge
   JA001007Administered intravenously                                                      Administered intravenously                                                                                                                C                                     02007010120070101        N
   JB001007Administered subcutaneously                                                     Administered subcutaneously                                                                                                               C                                     02007010120070101        N
   JC001007Skin substitute used as a graft                                                 Skin substitute graft                                                                                                                     C                                     02009010120090101        N
   JD001007Skin substitute not used as a graft                                             Skin sub not used as a graft                                                                                                              C                                     02009010120090101        N
   JW001007Drug amount discarded/not administered to any patient                           Discarded drug not administe                                                                                                              C                                     02003010120030101        N
   K0001007Lower extremity prosthesis functional level 0 - does not have the ability or    Lwr ext prost functnl lvl 0                                                                                                               C                                     01993010120030101        N
   K0002008potential to ambulate or transfer safely with or without assistance and a
   K0003008prosthesis does not enhance their quality of life or mobility.
   K1001007Lower extremity prosthesis functional level 1 - has the ability or potential to Lwr ext prost functnl lvl 1                                                                                                               C                                     01993010119970101        N
   K1002008use a prosthesis for transfers or ambulation on level surfaces at fixed
   K1003008cadence. Typical of the limited and unlimited household ambulator.
   K2001007Lower extremity prosthesis functional level 2 - has the ability or potential    Lwr ext prost functnl lvl 2                                                                                                               C                                     01993010119970101        N
   K2002008for ambulation with the ability to traverse low level environmental barriers
   K2003008such as curbs, stairs or uneven surfaces. Typical of the limited community
   K2004008ambulator.
   K3001007Lower extremity prosthesis functional level 3 - has the ability or potential    Lwr ext prost functnl lvl 3                                                                                                               C                                     01993010119970101        N
   K3002008for ambulation with variable cadence. Typical of the community ambulator who
   K3003008has the ability to transverse most environmental barriers and may have
   K3004008vocational, therapeutic, or exercise activity that demands prosthetic
   K3005008utilization beyond simple locomotion.
   K4001007Lower extremity prosthesis functional level 4 - has the ability or potential    Lwr ext prost functnl lvl 4                                                                                                               C                                     01993010119970101        N
   K4002008for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting
   K4003008high impact, stress, or energy levels, typical of the prosthetic demands of the
   K4004008child, active adult, or athlete.
   KA001007Add on option/accessory for wheelchair                                          Wheelchair add-on option/acc                                                                                                              C                                     01994010119970101        N
   KB001007Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim>4 modifiers on claim                                                                                                                     C                                     02003010120030101        N
   KC001007Replacement of special power wheelchair interface                               Repl special pwr wc intrface                                                                                                              C                                     02005010120050101        N
   KD001007Drug or biological infused through dme                                          Drug/biological DME infused                                                                                                               C                                     02004010120040101        N
   KE001007Bid under round one of the dmepos competitive bidding program for use with      Bid under round 1 DMEPOS CB                                                                                                               C                                     02009010120090101        N
   KE002008non-competitive bid base equipment
   KF001007Item designated by fda as class iii device                                      FDA class III device                                                                                                                      C                                     02004040120040401        N
   KG001007Dmepos item subject to dmepos competitive bidding program number 1              DMEPOS comp bid prgm no 1                                                                                                                 C                                     02007070120070701        N
   KH001007Dmepos item, initial claim, purchase or first month rental                      DMEPOS ini clm, pur/1 mo rnt                                                                                                              C                                     01994010119970101        N
   KI001007Dmepos item, second or third month rental                                       DMEPOS 2nd or 3rd mo rental                                                                                                               C                                     01994010119970101        N
   KJ001007Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months   DMEPOS PEN pmp or 4-15mo rnt                                                                                                              C                                     01994010119970101        N
   KJ002008four to fifteen
   KK001007Dmepos item subject to dmepos competitive bidding program number 2              DMEPOS comp bid prgm no 2                                                                                                                 C                                     02007070120070701        N
   KL001007Dmepos item delivered via mail                                                  DMEPOS mailorder comp bid                                                                                                                 C                                     02007070120090101        N
   KM001007Replacement of facial prosthesis including new impression/moulage               Rplc facial prosth new imp                                                                                                                C                                     01996010120010101        N
   KN001007Replacement of facial prosthesis using previous master model                    Rplc facial prosth old mod                                                                                                                C                                     01996010120010101        N
   KO001007Single drug unit dose formulation                                               Single drug unit dose form                                                                                                                C                                     01997040119970401        N
   KP001007First drug of a multiple drug unit dose formulation                             First drug of multi drug u d                                                                                                              C                                     01997040119970401        N
   KQ001007Second or subsequent drug of a multiple drug unit dose formulation              2nd/subsqnt drg multi drg ud                                                                                                              C                                     01997040119970401        N
   KR001007Rental item, billing for partial month                                          Rental item partial month                                                                                                                 C                                     02002010120020101        N
   KS001007Glucose monitor supply for diabetic beneficiary not treated with insulin        Glucose monitor supply                                                                                                                    D                      0074           01998100119981001        N
   KT001007Beneficiary resides in a competitive bidding area and travels outside that      Item from noncontract supply                                                                                                              C                                     02007070120080401        N
   KT002008competitive bidding area and receives a competitive bid item
   KU001007Dmepos item subject to dmepos competitive bidding program number 3              DMEPOS comp bid prgm no 3                                                                                                                 C                                     02007070120070701        N
   KV001007Dmepos item subject to dmepos competitive bidding program that is furnished as  DMEPOS item, profession serv                                                                                                              C                                     02008010120080101        N
   KV002008part of a professional service
   KW001007Dmepos item subject to dmepos competitive bidding program number 4              DMEPOS comp bid prgm no 4                                                                                                                 C                                     02008010120080101        N
   KX001007Requirements specified in the medical policy have been met                      Documentation on file                                                                                                                     C                                     02002070120020701        N
   KY001007Dmepos item subject to dmepos competitive bidding program number 5              DMEPOS comp bid prgm no 5                                                                                                                 C                                     02008010120080101        N
   KZ001007New coverage not implemented by managed care                                    New cov not implement by m+c                                                                                                              C                                     02003100120031001        N
   LC001007Left circumflex coronary artery                                                 Lft circum coronary artery                                                                                                                C                                     01997010119970101        N
   LD001007Left anterior descending coronary artery                                        Left ant des coronary artery                                                                                                              C                                     01997010119970101        N
   LL001007Lease/rental (use the 'll' modifier when dme equipment rental is to be applied  Lease/rental (appld to pur)                                                                                                               C                                     01984010119970101        N
   LL002008against the purchase price)
   LM001007Left main coronary artery                                                       Left main coronary artery                                                                                                                 C                                     02013010120130101        A
   LR001007Laboratory round trip                                                           Laboratory round trip                                                                                                                     C                                     01987010119970101        N
   LS001007Fda-monitored intraocular lens implant                                          FDA-monitored IOL implant            65-7                                                                                                 D                                     01991010119970101        N
   LT001007Left side (used to identify procedures performed on the left side of the body)  Left side                                                                                                                                 C                                     01984010119970101        N
   M2001007Medicare secondary payer (msp)                                                  Medicare secondary payer                                                                                                                  C                                     02007010120070101        N
   MS001007Six month maintenance and servicing fee for reasonable and necessary parts and  6-mo maint/svc fee parts/lbr                                                                                                              C                                     01989010119970101        N
   MS002008labor which are not covered under any manufacturer or supplier warranty
   NB001007Nebulizer system, any type, fda-cleared for use with specific drug              Drug specific nebulizer                                                                                                                   C                                     02011010120110101        N
   NR001007New when rented (use the 'nr' modifier when dme which was new at the time of    New when rented                                                                                                                           C                                     01984010119970101        N
   NR002008rental is subsequently purchased)
   NU001007New equipment                                                                   New equipment                                                                                                                             C                                     01984010119970101        N
   P1001007A normal healthy patient                                                        Normal healthy patient                                                                                                                    C                                     02006010120060101        N
   P2001007A patient with mild systemic disease                                            Patient w/mild syst disease                                                                                                               C                                     02006010120060101        N
   P3001007A patient with severe systemic disease                                          Patient w/severe sys disease                                                                                                              C                                     02006010120060101        N
   P4001007A patient with severe systemic disease that is a constant threat to life        Pt w/sev sys dis threat life                                                                                                              C                                     02006010120060101        N
   P5001007A moribund patient who is not expected to survive without the operation         Pt not expect surv w/o oper                                                                                                               C                                     02006010120060101        N
   P6001007A declared brain-dead patient whose organs are being removed for donor purposes Brain-dead pt organs removed                                                                                                              C                                     02006010120060101        N
   PA001007Surgical or other invasive procedure on wrong body part                         Surgery, wrong body part                                                                                                                  I                                     02009070120090701        N
   PB001007Surgical or other invasive procedure on wrong patient                           Surgery, wrong patient                                                                                                                    I                                     02009070120090701        N
   PC001007Wrong surgery or other invasive procedure on patient                            Wrong surgery on patient                                                                                                                  I                                     02009070120090701        N
   PD001007Diagnostic or related non diagnostic item or service provided in a wholly owned Inp admit w/in 3 days                                                                                                                     C                                     02012010120120101        N
   PD002008or operated entity to a patient who is admitted as an inpatient within 3 days
   PI001007Positron emission tomography (pet) or pet/computed tomography (ct) to inform    PET tumor init tx strat                                                                                                                   C                                     02009070120090701        N
   PI002008the initial treatment strategy of tumors that are biopsy proven or strongly
   PI003008suspected of being cancerous based on other diagnostic testing
   PL001007Progressive addition lenses                                                     Progressive addition lenses                                                                                                               C                                     01989010119970101        N
   PS001007Positron emission tomography (pet) or pet/computed tomography (ct) to inform    PET tumor subsq tx strategy                                                                                                               C                                     02009070120090701        N
   PS002008the subsequent treatment strategy of cancerous tumors when the beneficiary's
   PS003008treating physician determines that the pet study is needed to inform subsequent
   PS004008anti-tumor strategy
   PT001007Colorectal cancer screening test; converted to diagnostic test or other         Clrctal screen to diagn                                                                                                                   C                                     02011010120110101        N
   PT002008procedure
   Q0001007Investigational clinical service provided in a clinical research study that is  Invest clinical research                                                                                                                  D                      0146           02008010120080101        N
   Q0002008in an approved clinical research study
   Q1001007Routine clinical service provided in a clinical research study that is in an    Routine clinical research                                                                                                                 D                      0146           02008010120080101        N
   Q1002008approved clinical research study
   Q2001007Hcfa/ord demonstration project procedure/service                                HCFA/ORD demo procedure/svc                                                                                                               C                      0046           01992010119970101        N
   Q3001007Live kidney donor surgery and related services                                  Live donor surgery/services                                                                                                               C                                     01995010120030101        N
   Q4001007Service for ordering/referring physician qualifies as a service exemption       Svc exempt - ordrg/rfrng MD                                                                                                               C                                     01994010119970101        N
   Q5001007Service furnished by a substitute physician under a reciprocal billing          Subst MD svc, recip bill arr                           3060.6                                                                             D                                     01993010119970101        N
   Q5002008arrangement
   Q6001007Service furnished by a locum tenens physician                                   Locum tenens MD service                                3060.7                                                                             D                                     01993010119970101        N
   Q7001007One class a finding                                                             One Class A finding                                                                                                                       C                                     01995010119970101        N
   Q8001007Two class b findings                                                            Two Class B findings                                                                                                                      C                                     01995010119970101        N
   Q9001007One class b and two class c findings                                            1 Class B & 2 Class C fndngs                                                                                                              C                                     01995010119970101        N
   QC001007Single channel monitoring                                                       Single channel monitoring                                                                                                                 C                                     01989010119970101        N
   QD001007Recording and storage in solid state memory by a digital recorder               Rcrdg/strg in sld st memory                                                                                                               C                                     01989010119970101        N
   QE001007Prescribed amount of oxygen is less than 1 liter per minute (lpm)               Prescribed oxygen < 1 LPM                                                                                                                 C                                     01989010119970101        N
   QF001007Prescribed amount of oxygen exceeds 4 liters per minute (lpm) and portable      Prscrbd oxygen >4 LPM & port                                                                                                              C                                     01989010119970101        N
   QF002008oxygen is prescribed
   QG001007Prescribed amount of oxygen is greater than 4 liters per minute(lpm)            Prescribed oxygen > 4 LPM                                                                                                                 C                                     01989010119970101        N
   QH001007Oxygen conserving device is being used with an oxygen delivery system           Oxygen cnsrvg dvc w del sys                                                                                                               C                                     01989010119970101        N
   QJ001007Services/items provided to a prisoner or patient in state or local custody,     Patient in state/locl custod                                                                                                              D                      0111           02003010120030101        N
   QJ002008however the state or local government, as applicable, meets the requirements in
   QJ00300842 cfr 411. 4 (b)
   QK001007Medical direction of two, three, or four concurrent anesthesia procedures       Med dir 2-4 cncrnt anes proc                           3350.5                                                                             D                                     01995010120010101        N
   QK002008involving qualified individuals
   QL001007Patient pronounced dead after ambulance called                                  Patient died after amb call                                                                                                               C                                     01999010119990101        N
   QM001007Ambulance service provided under arrangement by a provider of services          Ambulance arr by provider                                                                                                                 C                                     01996010119990101        N
   QN001007Ambulance service furnished directly by a provider of services                  Ambulance furn by provider                                                                                                                C                                     01996010119990101        N
   QP001007Documentation is on file showing that the laboratory test(s) was ordered        Individually ordered lab tst                           7517.1                                                                             D                                     01996010119960301        N
   QP002008individually or ordered as a cpt-recognized panel other than automated profile
   QP003008codes 80002-80019, g0058, g0059, and g0060.
   QS001007Monitored anesthesia care service                                               Monitored anesthesia care            15018I                                                                                               D                                     01990010119960701        N
   QT001007Recording and storage on tape by an analog tape recorder                        Rcrdg/strg tape analog recdr                                                                                                              C                                     01989010119970101        N
   QW001007Clia waived test                                                                CLIA waived test                                                                                                                          C                                     01996010119961001        N
   QX001007Crna service: with medical direction by a physician                             CRNA svc w/ MD med direction                                                                                                              C                                     01993010119970101        N
   QY001007Medical direction of one certified registered nurse anesthetist (crna) by an    Medically directed CRNA                                3350.5                                                                             D                                     01998010120010101        N
   QY002008anesthesiologist
   QZ001007Crna service: without medical direction by a physician                          CRNA svc w/o med dir by MD                                                                                                                C                                     01993010119970101        N
   RA001007Replacement of a dme, orthotic or prosthetic item                               Replacement of DME item                                                                                                                   C                                     02009010120110101        N
   RB001007Replacement of a part of a dme, orthotic or prosthetic item furnished as part   Replacement part, DME item                                                                                                                C                                     02009010120110101        N
   RB002008of a repair
   RC001007Right coronary artery                                                           Right coronary artery                                                                                                                     C                                     01997010119970101        N
   RD001007Drug provided to beneficiary, but not administered "incident-to"                Drug admin not incident-to                                                                                                                C                                     02004010120040101        N
   RE001007Furnished in full compliance with fda-mandated risk evaluation and mitigation   Furnish full compliance REMS                                                                                                              C                                     02009010120090101        N
   RE002008strategy (rems)
   RI001007Ramus intermedius coronary artery                                               Ramus intermedius cor artery                                                                                                              C                                     02013010120130101        A
   RR001007Rental (use the 'rr' modifier when dme is to be rented)                         Rental (DME)                                                                                                                              C                                     01984010119970101        N
   RT001007Right side (used to identify procedures performed on the right side of the body)Right side                                                                                                                                C                                     01984010119970101        N
   SA001007Nurse practitioner rendering service in collaboration with a physician          Nurse practitioner w physici                                                                                                              I                                     02001070120010701        N
   SB001007Nurse midwife                                                                   Nurse midwife                                                                                                                             I                                     02001070120010701        N
   SC001007Medically necessary service or supply                                           Medically necessary serv/sup                                                                                                              C                                     02001070120110401        N
   SD001007Services provided by registered nurse with specialized, highly technical home   Serv by home infusion RN                                                                                                                  I                                     02001070120010701        N
   SD002008infusion training
   SE001007State and/or federally-funded programs/services                                 State/fed funded program/ser                                                                                                              I                                     02001070120010701        N
   SF001007Second opinion ordered by a professional review organization (pro) per section  2nd opinion ordered by PRO                                                                                                                C                                     01987010119970101        N
   SF0020089401, p. L. 99-272 (100% reimbursement - no medicare deductible or coinsurance)
   SG001007Ambulatory surgical center (asc) facility service                               ASC facility service                                                                                                                      C                                     01992010119970101        N
   SH001007Second concurrently administered infusion therapy                               2nd concurrent infusion ther                                                                                                              I                                     02001070120010701        N
   SJ001007Third or more concurrently administered infusion therapy                        3rd concurrent infusion ther                                                                                                              I                                     02001070120010701        N
   SK001007Member of high risk population (use only with codes for immunization)           High risk population                                                                                                                      I                                     02002040120020401        N
   SL001007State supplied vaccine                                                          State supplied vaccine                                                                                                                    I                                     02002040120020401        N
   SM001007Second surgical opinion                                                         Second opinion                                                                                                                            I                                     02002070120020701        N
   SN001007Third surgical opinion                                                          Third opinion                                                                                                                             I                                     02002070120020701        N
   SQ001007Item ordered by home health                                                     Item ordered by home health                                                                                                               I                                     02002100120021001        N
   SS001007Home infusion services provided in the infusion suite of the iv therapy providerHIT in infusion suite                                                                                                                     I                                     02004100120041001        N
   ST001007Related to trauma or injury                                                     Related to trauma or injury                                                                                                               I                                     02003010120030101        N
   SU001007Procedure performed in physician's office (to denote use of facility and        Performed in phys office                                                                                                                  I                                     02003010120030101        N
   SU002008equipment)
   SV001007Pharmaceuticals delivered to patient's home but not utilized                    Drugs delivered not used                                                                                                                  I                                     02003010120030101        N
   SW001007Services provided by a certified diabetic educator                              Serv by cert diab educator                                                                                                                C                                     02004040120040401        N
   SY001007Persons who are in close contact with member of high-risk population (use only  Contact w/high-risk pop                                                                                                                   I                                     02005010120050101        N
   SY002008with codes for immunization)
   T1001007Left foot, second digit                                                         Left foot, second digit                                                                                                                   C                                     01995010119990101        N
   T2001007Left foot, third digit                                                          Left foot, third digit                                                                                                                    C                                     01995010119990101        N
   T3001007Left foot, fourth digit                                                         Left foot, fourth digit                                                                                                                   C                                     01995010119990101        N
   T4001007Left foot, fifth digit                                                          Left foot, fifth digit                                                                                                                    C                                     01995010119990101        N
   T5001007Right foot, great toe                                                           Right foot, great toe                                                                                                                     C                                     01995010119990101        N
   T6001007Right foot, second digit                                                        Right foot, second digit                                                                                                                  C                                     01995010119990101        N
   T7001007Right foot, third digit                                                         Right foot, third digit                                                                                                                   C                                     01995010119990101        N
   T8001007Right foot, fourth digit                                                        Right foot, fourth digit                                                                                                                  C                                     01995010119990101        N
   T9001007Right foot, fifth digit                                                         Right foot, fifth digit                                                                                                                   C                                     01995010119990101        N
   TA001007Left foot, great toe                                                            Left foot, great toe                                                                                                                      C                                     01995010119990101        N
   TC001007Technical component; under certain circumstances, a charge may be made for the  Technical component                                                                                                                       C                                     01984010119970101        N
   TC002008technical component alone;  under those circumstances the technical component
   TC003008charge is identified by adding modifier 'tc' to the usual procedure number;
   TC004008technical component charges are institutional charges and not billed separately
   TC005008by physicians; however, portable x-ray suppliers only bill for technical
   TC006008component and should utilize modifier tc; the charge data from portable x-ray
   TC007008suppliers will then be used to build customary and prevailing profiles
   TD001007Rn                                                                              RN                                                                                                                                        I                                     02001070120010701        N
   TE001007Lpn/lvn                                                                         LPN/LVN                                                                                                                                   I                                     02001070120010701        N
   TF001007Intermediate level of care                                                      Intermediate level of care                                                                                                                I                                     02001070120010701        N
   TG001007Complex/high tech level of care                                                 Complex/High Tech level care                                                                                                              I                                     02001070120010701        N
   TH001007Obstetrical treatment/services, prenatal or postpartum                          OB TX/Srvcs prenatl/postpart                                                                                                              I                                     02001070120010701        N
   TJ001007Program group, child and/or adolescent                                          Child/adolescent program gp                                                                                                               I                                     02001070120010701        N
   TK001007Extra patient or passenger, non-ambulance                                       Extra patient or passenger                                                                                                                I                                     02002040120020401        N
   TL001007Early intervention/individualized family service plan (ifsp)                    Early intervention IFSP                                                                                                                   I                                     02002040120020401        N
   TM001007Individualized education program (iep)                                          Individualized ed prgrm(IEP)                                                                                                              I                                     02002040120020401        N
   TN001007Rural/outside providers' customary service area                                 Rural/out of service area                                                                                                                 I                                     02002040120020401        N
   TP001007Medical transport, unloaded vehicle                                             Med transprt unloaded vehicl                                                                                                              I                                     02002040120020401        N
   TQ001007Basic life support transport by a volunteer ambulance provider                  BLS by volunteer amb providr                                                                                                              I                                     02002040120020401        N
   TR001007School-based individualized education program (iep) services provided outside   School-based IEP out of dist                                                                                                              I                                     02002070120020701        N
   TR002008the public school district responsible for the student
   TS001007Follow-up service                                                               Follow-up service                                                                                                                         C                                     02002100120060101        N
   TT001007Individualized service provided to more than one patient in same setting        Additional patient                                                                                                                        I                                     02002100120021001        N
   TU001007Special payment rate, overtime                                                  Overtime payment rate                                                                                                                     I                                     02003010120030101        N
   TV001007Special payment rates, holidays/weekends                                        Holiday/weekend payment rate                                                                                                              I                                     02003010120030101        N
   TW001007Back-up equipment                                                               Back-up equipment                                                                                                                         I                                     02003010120030101        N
   U1001007Medicaid level of care 1, as defined by each state                              M/caid care lev 1 state def                                                                                                               I                                     02002070120020701        N
   U2001007Medicaid level of care 2, as defined by each state                              M/caid care lev 2 state def                                                                                                               I                                     02002070120020701        N
   U3001007Medicaid level of care 3, as defined by each state                              M/caid care lev 3 state def                                                                                                               I                                     02002070120020701        N
   U4001007Medicaid level of care 4, as defined by each state                              M/caid care lev 4 state def                                                                                                               I                                     02002070120020701        N
   U5001007Medicaid level of care 5, as defined by each state                              M/caid care lev 5 state def                                                                                                               I                                     02002070120020701        N
   U6001007Medicaid level of care 6, as defined by each state                              M/caid care lev 6 state def                                                                                                               I                                     02002070120020701        N
   U7001007Medicaid level of care 7, as defined by each state                              M/caid care lev 7 state def                                                                                                               I                                     02002070120020701        N
   U8001007Medicaid level of care 8, as defined by each state                              M/caid care lev 8 state def                                                                                                               I                                     02002070120020701        N
   U9001007Medicaid level of care 9, as defined by each state                              M/caid care lev 9 state def                                                                                                               I                                     02002070120020701        N
   UA001007Medicaid level of care 10, as defined by each state                             M/caid care lev 10 state def                                                                                                              I                                     02002070120020701        N
   UB001007Medicaid level of care 11, as defined by each state                             M/caid care lev 11 state def                                                                                                              I                                     02002070120020701        N
   UC001007Medicaid level of care 12, as defined by each state                             M/caid care lev 12 state def                                                                                                              I                                     02002070120020701        N
   UD001007Medicaid level of care 13, as defined by each state                             M/caid care lev 13 state def                                                                                                              I                                     02002070120020701        N
   UE001007Used durable medical equipment                                                  Used durable med equipment                                                                                                                C                                     01984010119970101        N
   UF001007Services provided in the morning                                                Services provided, morning                                                                                                                I                                     02003040120030401        N
   UG001007Services provided in the afternoon                                              Services provided, afternoon                                                                                                              I                                     02003040120030401        N
   UH001007Services provided in the evening                                                Services provided, evening                                                                                                                I                                     02003040120030401        N
   UJ001007Services provided at night                                                      Services provided, night                                                                                                                  I                                     02003040120030401        N
   UK001007Services provided on behalf of the client to someone other than the client      Svc on behalf client-collat                                                                                                               I                                     02003040120030401        N
   UK002008(collateral relationship)
   UN001007Two patients served                                                             Two patients served                                                                                                                       C                      0114           02004010120040101        N
   UP001007Three patients served                                                           Three patients served                                                                                                                     C                      0114           02004010120040101        N
   UQ001007Four patients served                                                            Four patients served                                                                                                                      C                      0114           02004010120040101        N
   UR001007Five patients served                                                            Five patients served                                                                                                                      C                      0114           02004010120040101        N
   US001007Six or more patients served                                                     Six or more patients served                                                                                                               C                      0114           02004010120040101        N
   V5001007Vascular catheter (alone or with any other vascular access)                     Vascular catheter                                                                                                                         C                                     02010010120100701        N
   V6001007Arteriovenous graft (or other vascular access not including a vascular catheter)Arteriovenous graft                                                                                                                       C                                     02010010120100701        N
   V7001007Arteriovenous fistula only (in use with two needles)                            Arteriovenous fistula                                                                                                                     C                                     02010010120100701        N
   V8001007Infection present                                                               Infection present                                                                                                                         C                                     0201001012012040120120331D
   V9001007No infection present                                                            No infection present                                                                                                                      C                                     0201001012012040120120331D
   VP001007Aphakic patient                                                                 Aphakic patient                                                                                                                           C                                     01984010119970101        N
A0021001003Ambulance service, outside state per mile, transport (medicaid only)            Outside state ambulance serv00      9                                                                            A0030                    I                          O1A D      01985010119960910        N
A0080001003Non-emergency transportation, per mile - vehicle provided by volunteer          Noninterest escort in non er00      9                                                                                                     I                          O1A D      01982010120030101        N
A0080002004(individual or organization), with no vested interest
A0090001003Non-emergency transportation, per mile - vehicle provided by individual (family Interest escort in non er   00      9                                                                                                     I                          O1A D      01982010120030101        N
A0090002004member, self, neighbor) with vested interest
A0100001003Non-emergency transportation; taxi                                              Nonemergency transport taxi 00      9                                                                                                     I                          O1A D      01982010120030101        N
A0110001003Non-emergency transportation and bus, intra or inter state carrier              Nonemergency transport bus  00      9                                                                                                     I                          O1A D      01984010119950101        N
A0120001003Non-emergency transportation: mini-bus, mountain area transports, or other      Noner transport mini-bus    00      9                                                                                                     I                          O1A D      01982010120030101        N
A0120002004transportation systems
A0130001003Non-emergency transportation: wheel-chair van                                   Noner transport wheelch van 00      9                                                                                                     I                          O1A D      01982010119950101        N
A0140001003Non-emergency transportation and air travel (private or commercial) intra or    Nonemergency transport air  00      9                                                                                                     I                          O1A D      01985010119960910        N
A0140002004inter state
A0160001003Non-emergency transportation: per mile - case worker or social worker           Noner transport case worker 00      9                                                                                                     I                          O1A D      01984010119950101        N
A0170001003Transportation ancillary:  parking fees, tolls, other                           Transport parking fees/tolls00      9                                                                                                     I                          O1A D      01982010120030101        N
A0180001003Non-emergency transportation: ancillary:  lodging-recipient                     Noner transport lodgng recip00      9                                                                                                     I                          O1A D      01982010119950101        N
A0190001003Non-emergency transportation: ancillary:  meals-recipient                       Noner transport meals recip 00      9                                                                                                     I                          O1A D      01984010119950101        N
A0200001003Non-emergency transportation: ancillary:  lodging escort                        Noner transport lodgng escrt00      9                                                                                                     I                          O1A D      01982010119950101        N
A0210001003Non-emergency transportation: ancillary:  meals-escort                          Noner transport meals escort00      9                                                                                                     I                          O1A D      01984010119950101        N
A0225001003Ambulance service, neonatal transport, base rate, emergency transport, one way  Neonatal emergency transport00      9                                                                                                     I                          O1A D      01985010120030401        N
A0380001003Bls mileage (per mile)                                                          Basic life support mileage  00      9                                                                            A0425                    I                          O1A D      01995010120030101        N
A0382001003Bls routine disposable supplies                                                 Basic support routine suppls52      A                                                                                                     C                          O1A D      01995010119950101        N
A0384001003Bls specialized service disposable supplies; defibrillation (used by als        Bls defibrillation supplies 52      A                                                                                                     C                          O1A D      01995010119950101        N
A0384002004ambulances and bls ambulances in jurisdictions where defibrillation is
A0384003004permitted in bls ambulances)
A0390001003Als mileage (per mile)                                                          Advanced life support mileag00      9                                                                            A0425                    I                          O1A D      01995010120030101        N
A0392001003Als specialized service disposable supplies; defibrillation (to be used only in Als defibrillation supplies 52      A                                                                                                     C                          O1A D      01995010119950101        N
A0392002004jurisdictions where defibrillation cannot be performed in bls ambulances)
A0394001003Als specialized service disposable supplies; iv drug therapy                    Als IV drug therapy supplies52      A                                                                                                     C                          O1A D      01995010119950101        N
A0396001003Als specialized service disposable supplies; esophageal intubation              Als esophageal intub suppls 52      A                                                                                                     C                          O1A D      01995010119950101        N
A0398001003Als routine disposable supplies                                                 Als routine disposble suppls52      A                                                                                                     C                          O1A D      01995010119950101        N
A0420001003Ambulance waiting time (als or bls), one half (1/2) hour increments             Ambulance waiting 1/2 hr    52      A                                                                                                     C                          O1A D      01995010119950101        N
A0422001003Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation    Ambulance 02 life sustaining52      A                                                                                                     C                          O1A D      01995010119950101        N
A0424001003Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); Extra ambulance attendant   52      A                                                                                                     C                          O1A D      01995010120030101        N
A0424002004(requires medical review)
A0425001003Ground mileage, per statute mile                                                Ground mileage              52      A                                                                                                     C                          O1A D      02001010120010101        N
A0426001003Ambulance service, advanced life support, non-emergency transport, level 1 (als Als 1                       52      A                                                                                                     C                          O1A D      02001010120010101        N
A04260020041)
A0427001003Ambulance service, advanced life support, emergency transport, level 1          ALS1-emergency              52      A                                                                                                     C                          O1A D      02001010120010101        N
A0427002004(als1-emergency)
A0428001003Ambulance service, basic life support, non-emergency transport, (bls)           bls                         52      A                                                                                                     C                          O1A D      02001010120010101        N
A0429001003Ambulance service, basic life support, emergency transport (bls-emergency)      BLS-emergency               52      A                                                                                                     C                          O1A D      02001010120010101        N
A0430001003Ambulance service, conventional air services, transport, one way (fixed wing)   Fixed wing air transport    52      A                                                                                                     C                          O1A D      02001010120010101        N
A0431001003Ambulance service, conventional air services, transport, one way (rotary wing)  Rotary wing air transport   52      A                                                                                                     C                          O1A D      02001010120010101        N
A0432001003Paramedic intercept (pi), rural area, transport furnished by a volunteer        PI volunteer ambulance co   52      A                                                                                                     C                          O1A D      02001010120010101        N
A0432002004ambulance company which is prohibited by state law from billing third party
A0432003004payers
A0433001003Advanced life support, level 2 (als 2)                                          als 2                       52      A                                                                                                     C                          O1A D      02001010120010101        N
A0434001003Specialty care transport (sct)                                                  Specialty care transport    52      A                                                                                                     C                          O1A D      02001010120010101        N
A0435001003Fixed wing air mileage, per statute mile                                        Fixed wing air mileage      52      A                                                                                                     C                          O1A D      02001010120010101        N
A0436001003Rotary wing air mileage, per statute mile                                       Rotary wing air mileage     52      A                                                                                                     C                          O1A D      02001010120010101        N
A0888001003Noncovered ambulance mileage, per mile (e. G. , for miles traveled beyond       Noncovered ambulance mileage00      9                  2125                                                                               M                          O1A D      01995010119950101        N
A0888002004closest appropriate facility)
A0998001003Ambulance response and treatment, no transport                                  Ambulance response/treatment00      9                                                                                                     I                          O1A D      02006010120060101        N
A0999001003Unlisted ambulance service                                                      Unlisted ambulance service  57      A                  2120.1  2125                                                                       D                          O1A D      01987010119980101        N
A4206001003Syringe with needle, sterile, 1 cc or less, each                                1 CC sterile syringe&needle 00      9                                                                                                     C                          D1A S      01985010120080101        N
A4207001003Syringe with needle, sterile 2cc, each                                          2 CC sterile syringe&needle 00      9                                                                                                     C                          D1A S      01985010120070101        N
A4208001003Syringe with needle, sterile 3cc, each                                          3 CC sterile syringe&needle 00      9                                                                                                     C                          D1A S      01985010120070101        N
A4209001003Syringe with needle, sterile 5cc or greater, each                               5+ CC sterile syringe&needle00      9                                                                                                     C                          D1A S      01985010120070101        N
A4210001003Needle-free injection device, each                                              Nonneedle injection device  00      960-9                                                                                                 M                          D1A S      01989010119960101        N
A4211001003Supplies for self-administered injections                                       Supp for self-adm injections00      9                  2049                                                                               D                          D1A S      01993010119970101        N
A4212001003Non-coring needle or stylet with or without catheter                            Non coring needle or stylet 57      A                                                                                                     C                          D1A S      01993010120000101        N
A4213001003Syringe, sterile, 20 cc or greater, each                                        20+ CC syringe only         00      9                                                                                                     C                          D1A S      01985010120070101        N
A4215001003Needle, sterile, any size, each                                                 Sterile needle              00      9                                                                                                     C                          D1A LS     01985010120070101        N
A4216001003Sterile water, saline and/or dextrose, diluent/flush, 10 ml                     Sterile water/saline, 10 ml 37      A                  2049                                                                               D                          D1F 1LP    02004010120070101        N
A4217001003Sterile water/saline, 500 ml                                                    Sterile water/saline, 500 ml37      A                  2049                                                                               D                          D1F 1LP    02004010120040101        N
A4218001003Sterile saline or water, metered dose dispenser, 10 ml                          Sterile saline or water     51      A                                                                                                     D                      0127O1E 1LP    02006010120060101        N
A4220001003Refill kit for implantable infusion pump                                        Infusion pump refill kit    57      A60-14                                                                                                D                      0050D1A P      01994010119980303        N
A4221001003Supplies for maintenance of drug infusion catheter, per week (list drug         Maint drug infus cath per wk34      A                                                                                                     C                          D1E P      01997010119970101        N
A4221002004separately)
A4222001003Infusion supplies for external drug infusion pump, per cassette or bag (list    Infusion supplies with pump 34      A                                                                                                     C                          D1E P      01997010120050101        N
A4222002004drugs separately)
A4223001003Infusion supplies not used with external infusion pump, per cassette or bag     Infusion supplies w/o pump  00      9                                                                                                     C                          D1A P      02005010120070101        N
A4223002004(list drugs separately)
A4230001003Infusion set for external insulin pump, non needle cannula type                 Infus insulin pump non needl34      A60-14                                                                                                D                          D1E P      01996010120000101        N
A4231001003Infusion set for external insulin pump, needle type                             Infusion insulin pump needle34      A60-14                                                                                                D                          D1E P      01996010120000101        N
A4232001003Syringe with needle for external insulin pump, sterile, 3cc                     Syringe w/needle insulin 3cc00      960-14                                                                                                I                          D1E P      01996010120030401        N
A4233001003Replacement battery, alkaline (other than j cell), for use with medically       Alkalin batt for glucose mon36      A                                                                                                     C                          D1E P      02006010120060101        N
A4233002004necessary home blood glucose monitor owned by patient, each
A4234001003Replacement battery, alkaline, j cell, for use with medically necessary home    J-cell batt for glucose mon 36      A                                                                                                     C                          D1E P      02006010120060101        N
A4234002004blood glucose monitor owned by patient, each
A4235001003Replacement battery, lithium, for use with medically necessary home blood       Lithium batt for glucose mon36      A                                                                                                     C                          D1E P      02006010120060101        N
A4235002004glucose monitor owned by patient, each
A4236001003Replacement battery, silver oxide, for use with medically necessary home blood  Silvr oxide batt glucose mon36      A                                                                                                     C                          D1E P      02006010120060101        N
A4236002004glucose monitor owned by patient, each
A4244001003Alcohol or peroxide, per pint                                                   Alcohol or peroxide per pint00      9                                                                                                     C                          D1A LS     01985010120070101        N
A4245001003Alcohol wipes, per box                                                          Alcohol wipes per box       00      9                                                                                                     C                          D1A LS     01985010120070101        N
A4246001003Betadine or phisohex solution, per pint                                         Betadine/phisohex solution  00      9                                                                                                     C                          D1A LS     01985010120070101        N
A4247001003Betadine or iodine swabs/wipes, per box                                         Betadine/iodine swabs/wipes 00      9                                                                                                     C                          D1A LS     01985010120070101        N
A4248001003Chlorhexidine containing antiseptic, 1 ml                                       Chlorhexidine antisept      52      A                                                                                                     C                          P9B L      02004010120040101        N
A4250001003Urine test or reagent strips or tablets (100 tablets or strips)                 Urine reagent strips/tablets00      9                  2100                                                                               M                          T1E 9      01990010119970101        N
A4252001003Blood ketone test or reagent strip, each                                        Blood ketone test or strip  00      9                                          1861(n)                                                    S                          D1E P      02008010120080101        N
A4253001003Blood glucose test or reagent strips for home blood glucose monitor, per 50     Blood glucose/reagent strips32      A60-11                                                                                                D                          D1E P      01986010119980701        N
A4253002004strips
A4255001003Platforms for home blood glucose monitor, 50 per box                            Glucose monitor platforms   34      A60-11                                                                                                D                          D1E P      01997010120020101        N
A4256001003Normal, low and high calibrator solution / chips                                Calibrator solution/chips   34      A60-11                                                                                                D                          D1E P      01985010120020101        N
A4257001003Replacement lens shield cartridge for use with laser skin piercing device, each Replace Lensshield Cartridge34      A                                                                                                     C                          D1E P      02002010120020101        N
A4258001003Spring-powered device for lancet, each                                          Lancet device each          34      A60-11                                                                                                D                          D1E P      01996010120020101        N
A4259001003Lancets, per box of 100                                                         Lancets per box             34      A60-11                                                                                                D                          D1E P      01985010119960101        N
A4261001003Cervical cap for contraceptive use                                              Cervical cap contraceptive  00      9                                          1862a1                                                     S                          Z2  9      01999010119990101        N
A4262001003Temporary, absorbable lacrimal duct implant, each                               Temporary tear duct plug    00      9                                                                                                     D                      0052D1A 9      01994010119980101        N
A4263001003Permanent, long term, non-dissolvable lacrimal duct implant, each               Permanent tear duct plug    11      A                  15030                                                                              D                          Y1  9      01994010119980101        N
A4264001003Permanent implantable contraceptive intratubal occlusion device(s) and delivery Intratubal occlusion device 00      9                                                                                                     I                          Z2  9      02010010120100101        N
A4264002004system
A4265001003Paraffin, per pound                                                             Paraffin                    34      A60-9                                                                                                 D                          D1E 9      01986010120020101        N
A4266001003Diaphragm for contraceptive use                                                 Diaphragm                   00      9                                                                                                     I                          Z2  9      02003010120030101        N
A4267001003Contraceptive supply, condom, male, each                                        Male condom                 00      9                                                                                                     I                          Z2  9      02003010120030101        N
A4268001003Contraceptive supply, condom, female, each                                      Female condom               00      9                                                                                                     I                          Z2  9      02003010120030101        N
A4269001003Contraceptive supply, spermicide (e. G. , foam, gel), each                      Spermicide                  00      9                                                                                                     I                          Z2  9      02003010120030101        N
A4270001003Disposable endoscope sheath, each                                               Disposable endoscope sheath 00      9                                                                                                     C                          P8D 9      01994010119950401        N
A4280001003Adhesive skin support attachment for use with external breast prosthesis, each  Brst prsths adhsv attchmnt  38      A                                                                                                     C                          D1F P      02000010120000101        N
A4281001003Tubing for breast pump, replacement                                             Replacement breastpump tube 00      9                                                                                                     C                          Z2  9      02003010120070101        N
A4282001003Adapter for breast pump, replacement                                            Replacement breastpump adpt 00      9                                                                                                     C                          Z2  9      02003010120070101        N
A4283001003Cap for breast pump bottle, replacement                                         Replacement breastpump cap  00      9                                                                                                     C                          Z2  9      02003010120070101        N
A4284001003Breast shield and splash protector for use with breast pump, replacement        Replcmnt breast pump shield 00      9                                                                                                     C                          Z2  9      02003010120070101        N
A4285001003Polycarbonate bottle for use with breast pump, replacement                      Replcmnt breast pump bottle 00      9                                                                                                     C                          Z2  9      02003010120070101        N
A4286001003Locking ring for breast pump, replacement                                       Replcmnt breastpump lok ring00      9                                                                                                     C                          Z2  9      02003010120070101        N
A4290001003Sacral nerve stimulation test lead, each                                        Sacral nerve stim test lead 00      9                                                                                                     C                          Z2  9      02001010120020101        N
A4300002003Implantable access catheter, (e,g. , venous, arterial, epidural subarachnoid,   Cath impl vasc access portal11      A                  2130                                                                               D                          Y1  S      01986010120020101        N
A4300003004or peritoneal, etc. ) external access
A4301001003Implantable access total catheter, port/reservoir (e. G. , venous, arterial,    Implantable access syst perc00      9                                                                                                     C                          D1A S      01996010120030101        N
A4301002004epidural, subarachnoid, peritoneal, etc. )
A4305001003Disposable drug delivery system, flow rate of 50 ml or greater per hour         Drug delivery system >=50 ML00      9                                                                                                     C                          D1A 9      01993010120060101        N
A4306001003Disposable drug delivery system, flow rate of less than 50 ml per hour          Drug delivery system <=50 ml00      9                                                                                                     C                          D1A 9      01993010120070101        N
A4310002003Insertion tray without drainage bag and without catheter (accessories only)     Insert tray w/o bag/cath    37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4311001003Insertion tray without drainage bag with indwelling catheter, foley type,       Catheter w/o bag 2-way latex37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4311002004two-way latex with coating (teflon, silicone, silicone elastomer or
A4311003004hydrophilic, etc. )
A4312001003Insertion tray without drainage bag with indwelling catheter, foley type,       Cath w/o bag 2-way silicone 37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4312002004two-way, all silicone
A4313001003Insertion tray without drainage bag with indwelling catheter, foley type,       Catheter w/bag 3-way        37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4313002004three-way, for continuous irrigation
A4314001003Insertion tray with drainage bag with indwelling catheter, foley type, two-way  Cath w/drainage 2-way latex 37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4314002004latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc. )
A4315001003Insertion tray with drainage bag with indwelling catheter, foley type, two-way, Cath w/drainage 2-way silcne37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4315002004all silicone
A4316001003Insertion tray with drainage bag with indwelling catheter, foley type,          Cath w/drainage 3-way       37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4316002004three-way, for continuous irrigation
A4320001003Irrigation tray with bulb or piston syringe, any purpose                        Irrigation tray             37      A                  2130                                                                               D                          D1A P      01990010119920101        N
A4321001003Therapeutic agent for urinary catheter irrigation                               Cath therapeutic irrig agent37      A                  2130                                                                               D                          D1F P      01997010120030101        N
A4322001003Irrigation syringe, bulb or piston, each                                        Irrigation syringe          37      A                  2130                                                                               D                          D1F P      01990010119960101        N
A4326001003Male external catheter with integral collection chamber,  any type, each        Male external catheter      37      A                  2130                                                                               D                          D1F P      01990010120070101        N
A4327001003Female external urinary collection device; meatal cup, each                     Fem urinary collect dev cup 37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4328001003Female external urinary collection device; pouch, each                          Fem urinary collect pouch   37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4330001003Perianal fecal collection pouch with adhesive, each                             Stool collection pouch      37      A                  2130                                                                               D                          D1F P      01990010119960101        N
A4331001003Extension drainage tubing, any type, any length, with connector/adaptor, for    Extension drainage tubing   37      A                  2130                                                                               D                          D1F P      02001010120030101        N
A4331002004use with urinary leg bag or urostomy pouch, each
A4332001003Lubricant, individual sterile packet, each                                      Lube sterile packet         37      A                  2130                                                                               D                          D1F P      02001010120050101        N
A4333001003Urinary catheter anchoring device, adhesive skin attachment, each               Urinary cath anchor device  37      A                  2130                                                                               D                          D1F P      02001010120030101        N
A4334001003Urinary catheter anchoring device, leg strap, each                              Urinary cath leg strap      37      A                  2130                                                                               D                          D1F P      02001010120030101        N
A4335001003Incontinence supply; miscellaneous                                              Incontinence supply         46      A                  2130                                                                               D                          D1F P      01990010119900101        N
A4336001003Incontinence supply, urethral insert, any type, each                            Urethral insert             37      A                                                                                                     D                      0124D1F P      02010010120100101        N
A4338001003Indwelling catheter; foley type, two-way latex with coating (teflon, silicone,  Indwelling catheter latex   37      A                  2130                                                                               D                          D1F P      01990010119960101        N
A4338002004silicone elastomer, or hydrophilic, etc. ), each
A4340001003Indwelling catheter; specialty type, eg; coude, mushroom, wing, etc. ), each    Indwelling catheter special 37      A                  2130                                                                               D                          D1F P      01990010119960101        N
A4344001003Indwelling catheter, foley type, two-way, all silicone, each                    Cath indw foley 2 way silicn37      A                  2130                                                                               D                          D1F P      01983010119960101        N
A4346001003Indwelling catheter; foley type, three way for continuous irrigation, each      Cath indw foley 3 way       37      A                  2130                                                                               D                          D1F P      01983010119960101        N
A4349001003Male external catheter, with or without adhesive, disposable, each              Disposable male external cat37      A                  2130                                                                               D                          D1A P      02005010120050101        N
A4351001003Intermittent urinary catheter; straight tip, with or without coating (teflon,   Straight tip urine catheter 37      A                  2130                                                                               D                          D1F P      01990010120020101        N
A4351002004silicone, silicone elastomer, or hydrophilic, etc. ), each
A4352001003Intermittent urinary catheter; coude (curved) tip, with or without coating      Coude tip urinary catheter  37      A                  2130                                                                               D                          D1F P      01990010120020101        N
A4352002004(teflon, silicone, silicone elastomeric, or hydrophilic, etc. ), each
A4353001003Intermittent urinary catheter, with insertion supplies                          Intermittent urinary cath   37      A                  2130                                                                               D                          D1F P      01997010120030101        N
A4354001003Insertion tray with drainage bag but without catheter                           Cath insertion tray w/bag   37      A                  2130                                                                               D                          D1F P      01986010119900101        N
A4355001003Irrigation tubing set for continuous bladder irrigation through a three-way     Bladder irrigation tubing   37      A                  2130                                                                               D                          D1F P      01984010119960101        N
A4355002004indwelling foley catheter, each
A4356002003External urethral clamp or compression device (not to be used for catheter      Ext ureth clmp or compr dvc 37      A                  2130                                                                               D                          D1F P      01985010119960101        N
A4356003004clamp), each
A4357001003Bedside drainage bag, day or night, with or without anti-reflux device, with or Bedside drainage bag        37      A                  2130                                                                               D                          D1F P      01985010119960101        N
A4357002004without tube, each
A4358002003Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, Urinary leg or abdomen bag  37      A                  2130                                                                               D                          D1F P      01985010120020101        N
A4358003004each
A4360001003Disposable external urethral clamp or compression device, with pad and/or       Disposable ext urethral dev 37      A                                                                                                     D                      0124D1F 9      02010010120100101        N
A4360002004pouch, each
A4361002003Ostomy faceplate, each                                                          Ostomy face plate           37      A                  2130                                                                               D                          D1F P      01985010119960101        N
A4362001003Skin barrier; solid, 4 x 4 or equivalent; each                                  Solid skin barrier          37      A                  2130                                                                               D                          D1F P      01985010119900101        N
A4363001003Ostomy clamp, any type, replacement only, each                                  Ostomy clamp, replacement   37      A                                                                                                     D                      0124D1F P      02006010120060101        N
A4364001003Adhesive, liquid or equal, any type,  per oz                                    Adhesive, liquid or equal   37      A                  2130                                                                               D                          D1F P      01985010120030101        N
A4365001003Adhesive remover wipes, any type, per 50                                        Adhesive remover wipes      37      A                  2130                                                                               D                          D1F P      0199701012010010120091231N
A4366001003Ostomy vent, any type, each                                                     Ostomy vent                 37      A                                                                                                     C                          D1F P      02004010120040101        N
A4367001003Ostomy belt, each                                                               Ostomy belt                 37      A                  2130A                                                                              D                          D1F P      01985010119960101        N
A4368001003Ostomy filter, any type, each                                                   Ostomy filter               37      A                                                                                                     C                          D1F P      01997010119970101        N
A4369001003Ostomy skin barrier, liquid (spray, brush, etc), per oz                         Skin barrier liquid per oz  37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4371001003Ostomy skin barrier, powder, per oz                                             Skin barrier powder per oz  37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4372001003Ostomy skin barrier, solid 4x4 or equivalent,  standard wear, with built-in     Skin barrier solid 4x4 equiv37      A                  2130                                                                               D                          D1F P      02000010120060101        N
A4372002004convexity, each
A4373001003Ostomy skin barrier, with flange (solid, flexible or accordian),  with built-in Skin barrier with flange    37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4373002004convexity, any size, each
A4375001003Ostomy pouch, drainable, with faceplate attached, plastic, each                 Drainable plastic pch w fcpl37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4376001003Ostomy pouch, drainable, with faceplate attached, rubber, each                  Drainable rubber pch w fcplt37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4377001003Ostomy pouch, drainable, for use on faceplate, plastic, each                    Drainable plstic pch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4378001003Ostomy pouch, drainable, for use on faceplate, rubber, each                     Drainable rubber pch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4379001003Ostomy pouch, urinary, with faceplate attached, plastic, each                   Urinary plastic pouch w fcpl37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4380001003Ostomy pouch, urinary, with faceplate attached, rubber, each                    Urinary rubber pouch w fcplt37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4381001003Ostomy pouch, urinary, for use on faceplate, plastic, each                      Urinary plastic pouch w/o fp37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4382001003Ostomy pouch, urinary, for use on faceplate, heavy plastic, each                Urinary hvy plstc pch w/o fp37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4383001003Ostomy pouch, urinary, for use on faceplate, rubber, each                       Urinary rubber pouch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4384001003Ostomy faceplate equivalent, silicone ring, each                                Ostomy faceplt/silicone ring37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4385001003Ostomy skin barrier, solid 4x4 or equivalent, extended wear, without built-in   Ost skn barrier sld ext wear37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4385002004convexity, each
A4387001003Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), Ost clsd pouch w att st barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4387002004each
A4388001003Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each   Drainable pch w ex wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4389001003Ostomy pouch, drainable, with barrier attached, with built-in convexity (1      Drainable pch w st wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4389002004piece), each
A4390001003Ostomy pouch, drainable, with extended wear barrier attached, with built-in     Drainable pch ex wear convex37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4390002004convexity (1 piece), each
A4391001003Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each      Urinary pouch w ex wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4392001003Ostomy pouch, urinary, with standard wear barrier attached, with built-in       Urinary pouch w st wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4392002004convexity (1 piece), each
A4393001003Ostomy pouch, urinary, with extended wear barrier attached, with built-in       Urine pch w ex wear bar conv37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4393002004convexity (1 piece), each
A4394001003Ostomy deodorant, with or without lubricant,  for use in ostomy pouch, per      Ostomy pouch liq deodorant  37      A                  2130                                                                               D                          D1F P      02000010120070101        N
A4394002004fluid ounce
A4395001003Ostomy deodorant for use in ostomy pouch, solid, per tablet                     Ostomy pouch solid deodorant37      A                  2130                                                                               D                          D1F P      02000010120030101        N
A4396001003Ostomy belt with peristomal hernia support                                      Peristomal hernia supprt blt37      A                  2130                                                                               D                          D1F P      02001010120030101        N
A4397001003Irrigation supply; sleeve, each                                                 Irrigation supply sleeve    37      A                  2130                                                                               D                          D1F P      01990010119960101        N
A4398001003Ostomy irrigation supply; bag, each                                             Ostomy irrigation bag       37      A                  2130                                                                               D                          D1F P      01989010119970101        N
A4399001003Ostomy irrigation supply; cone/catheter, with or without brush                  Ostomy irrig cone/cath w brs37      A                  2130                                                                               D                          D1F P      01989010120110101        N
A4400001003Ostomy irrigation set                                                           Ostomy irrigation set       37      A                  2130                                                                               D                          D1F P      01982010119900101        N
A4402001003Lubricant, per ounce                                                            Lubricant per ounce         37      A                  2130                                                                               D                          D1F P      01985010119950101        N
A4404001003Ostomy ring, each                                                               Ostomy ring each            37      A                  2130                                                                               D                          D1F P      01985010119950101        N
A4405001003Ostomy skin barrier, non-pectin based, paste, per ounce                         Nonpectin based ostomy paste37      A                  2130                                                                               D                          D1F P      02003010120030101        N
A4406001003Ostomy skin barrier, pectin-based, paste, per ounce                             Pectin based ostomy paste   37      A                  2130                                                                               D                          D1F P      02003010120030101        N
A4407001003Ostomy skin barrier, with flange (solid, flexible, or accordion), extended      Ext wear ost skn barr <=4sq"37      A                  2130                                                                               D                          D1F P      02003010120030101        N
A4407002004wear, with built-in convexity, 4 x 4 inches or smaller, each
A4408001003Ostomy skin barrier, wtih flange (solid, flexible or accordion), extended wear, Ext wear ost skn barr >4sq" 37      A                  2130                                                                               D                          D1F P      02003010120030101        N
A4408002004with built-in convexity, larger than 4 x 4 inches, each
A4409001003Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, Ost skn barr convex <=4 sq i37      A                  2130                                                                               D                          D1F P      02003010120060101        N
A4409002004without built-in convexity, 4 x 4 inches or smaller, each
A4410001003Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, Ost skn barr extnd >4 sq    37      A                  2130                                                                               D                          D1F P      02003010120060101        N
A4410002004without built-in convexity, larger than 4 x 4 inches, each
A4411001003Ostomy skin barrier, solid 4x4 or equivalent, extended wear, with built-in      Ost skn barr extnd =4sq     37      A                                                                                                     D                      0124D1F P      02006010120060101        N
A4411002004convexity, each
A4412001003Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece Ost pouch drain high output 37      A                  2130                                                                               D                      0124D1F P      02006010120060101        N
A4412002004system), without filter, each
A4413001003Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece 2 pc drainable ost pouch    37      A                  2130                                                                               D                          D1F P      02003010120030101        N
A4413002004system), with filter, each
A4414001003Ostomy skin barrier, with flange (solid, flexible or accordion), without        Ost sknbar w/o conv<=4 sq in37      A                  2130                                                                               D                          D1F P      02003010120060101        N
A4414002004built-in convexity, 4 x 4 inches or smaller, each
A4415001003Ostomy skin barrier, with flange (solid, flexible or accordion), without        Ost skn barr w/o conv >4 sqi37      A                  2130                                                                               D                          D1F P      02003010120060101        N
A4415002004built-in convexity, larger than 4x4 inches, each
A4416001003Ostomy pouch, closed, with barrier attached, with filter (1 piece), each        Ost pch clsd w barrier/filtr37      A                                                                                                     C                          D1F P      02004010120040101        N
A4417001003Ostomy pouch, closed, with barrier attached, with built-in convexity, with      Ost pch w bar/bltinconv/fltr37      A                                                                                                     C                          D1F P      02004010120040101        N
A4417002004filter (1 piece), each
A4418001003Ostomy pouch, closed; without barrier attached, with filter (1 piece), each     Ost pch clsd w/o bar w filtr37      A                                                                                                     C                          D1F P      02004010120040101        N
A4419001003Ostomy pouch, closed; for use on barrier with non-locking flange, with filter   Ost pch for bar w flange/flt37      A                                                                                                     C                          D1F P      02004010120040101        N
A4419002004(2 piece), each
A4420001003Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each    Ost pch clsd for bar w lk fl37      A                                                                                                     C                          D1F P      02004010120040101        N
A4421001003Ostomy supply; miscellaneous                                                    Ostomy supply misc          00      9                                                                                                     C                          D1F P      01985010120070101        N
A4422001003Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to Ost pouch absorbent material37      A                  2130                                                                               D                          D1F P      02003010120030101        N
A4422002004thicken liquid stomal output, each
A4423001003Ostomy pouch, closed; for use on barrier with locking flange, with filter (2    Ost pch for bar w lk fl/fltr37      A                                                                                                     C                          D1F P      02004010120040101        N
A4423002004piece), each
A4424001003Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each     Ost pch drain w bar & filter37      A                                                                                                     C                          D1F P      02004010120040101        N
A4425001003Ostomy pouch, drainable; for use on barrier with non-locking flange, with       Ost pch drain for barrier fl37      A                                                                                                     C                          D1F P      02004010120040101        N
A4425002004filter (2 piece system), each
A4426001003Ostomy pouch, drainable; for use on barrier with locking flange (2 piece        Ost pch drain 2 piece system37      A                                                                                                     C                          D1F P      02004010120040101        N
A4426002004system), each
A4427001003Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 Ost pch drain/barr lk flng/f37      A                                                                                                     C                          D1F P      02004010120040101        N
A4427002004piece system), each
A4428001003Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type    Urine ost pouch w faucet/tap37      A                                                                                                     C                          D1F P      02004010120040101        N
A4428002004tap with valve (1 piece), each
A4429001003Ostomy pouch, urinary, with barrier attached, with built-in convexity, with     Urine ost pouch w bltinconv 37      A                                                                                                     C                          D1F P      02004010120040101        N
A4429002004faucet-type tap with valve (1 piece), each
A4430001003Ostomy pouch, urinary, with extended wear barrier attached, with built-in       Ost urine pch w b/bltin conv37      A                                                                                                     C                          D1F P      02004010120040101        N
A4430002004convexity, with faucet-type tap with valve (1 piece), each
A4431001003Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve   Ost pch urine w barrier/tapv37      A                                                                                                     C                          D1F P      02004010120040101        N
A4431002004(1 piece), each
A4432001003Ostomy pouch, urinary; for use on barrier with non-locking flange, with         Os pch urine w bar/fange/tap37      A                                                                                                     C                          D1F P      02004010120040101        N
A4432002004faucet-type tap with valve (2 piece), each
A4433001003Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each   Urine ost pch bar w lock fln37      A                                                                                                     C                          D1F P      02004010120040101        N
A4434001003Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type Ost pch urine w lock flng/ft37      A                                                                                                     C                          D1F P      02004010120040101        N
A4434002004tap with valve (2 piece), each
A4435001003Ostomy pouch, drainable, high output, with extended wear barrier (one-piece     1pc ost pch drain hgh output37      A                                                                                                     C                          D1F P      02013010120130101        A
A4435002004system), with or without filter, each
A4450001003Tape, non-waterproof, per 18 square inches                                      Non-waterproof tape         37      A                  2130                                                                               D                          D1F LP     02003010120030101        N
A4452001003Tape, waterproof, per 18 square inches                                          Waterproof tape             37      A                  2130                                                                               D                          D1F LP     02003010120030101        N
A4455001003Adhesive remover or solvent (for tape, cement or other adhesive), per ounce     Adhesive remover per ounce  37      A                  2130                                                                               D                          D1F P      01989010119950101        N
A4456001003Adhesive remover, wipes, any type, each                                         Adhesive remover, wipes     37      A                  2130                                                                               D                          D1F P      02010010120100101        N
A4458001003Enema bag with tubing, reusable                                                 Reusable enema bag          00      9                                                                                                     C                          Z2  9      02003010120070101        N
A4461001003Surgical dressing holder, non-reusable, each                                    Surgicl dress hold non-reuse35      A                                                                                                     C                          D1A S      02007010120070101        N
A4463001003Surgical dressing holder, reusable, each                                        Surgical dress holder reuse 35      A                                                                                                     C                          D1A S      02007010120070101        N
A4465001003Non-elastic binder for extremity                                                Non-elastic extremity binder00      9                                                                                                     C                          D1A 9      01994010119950101        N
A4466001003Garment, belt, sleeve or other covering, elastic or similar stretchable         Elastic garment/covering    00      9                                                                                                     I                          Z2  9      02010010120100101        N
A4466002004material, any type, each
A4470001003Gravlee jet washer                                                              Gravlee jet washer          00      950-4              2320                                                                               D                          D1A P      01986010120010101        N
A4480001003Vabra aspirator                                                                 Vabra aspirator             00      950-10             2320                                                                               D                          D1A P      01986010120010101        N
A4481001003Tracheostoma filter, any type, any size, each                                   Tracheostoma filter         37      A                  2130                                                                               D                          D1F P      01997010120030101        N
A4483001003Moisture exchanger, disposable, for use with invasive mechanical ventilation    Moisture exchanger          37      A                  2130                                                                               D                          D1F P      01999010120030101        N
A4490001003Surgical stockings above knee length, each                                      Above knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N
A4495001003Surgical stockings thigh length, each                                           Thigh length surg stocking  00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N
A4500001003Surgical stockings below knee length, each                                      Below knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N
A4510001003Surgical stockings full length, each                                            Full length surg stocking   00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N
A4520001003Incontinence garment, any type, (e. G. Brief, diaper), each                     Incontinence garment anytype00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
A4550001003Surgical trays                                                                  Surgical trays              11      A                  15030                                                                              D                          Y1  9      01982010120000101        N
A4554001003Disposable underpads, all sizes                                                 Disposable underpads        00      960-9                                                                                                 M                          D1A 9      01986010120050101        N
A4556001003Electrodes, (e. G. , apnea monitor), per pair                                   Electrodes, pair            34      A                                                                                                     C                          D1E P      01984010120000101        N
A4557001003Lead wires, (e. G. , apnea monitor), per pair                                   Lead wires, pair            34      A                                                                                                     C                          D1E P      01984010120000101        N
A4558001003Conductive gel or paste, for use with electrical device (e. G. , tens, nmes),   Conductive gel or paste     34      A                                                                                                     C                          D1E P      01985010120070101        N
A4558002004per oz
A4559001003Coupling gel or paste, for use with ultrasound device, per oz                   Coupling gel or paste       34      A                                                                                                     C                          D1E P      02007010120070101        N
A4561001003Pessary, rubber, any type                                                       Pessary rubber, any type    38      A                                                                                                     C                          D1F P      02001010120010101        N
A4562001003Pessary, non rubber, any type                                                   Pessary, non rubber,any type38      A                                                                                                     C                          D1F P      02001010120010101        N
A4565001003Slings                                                                          Slings                      52      A                                                                                                     C                          D1A P      01983010119960101        N
A4566001003Shoulder sling or vest design, abduction restrainer, with or without swathe     Should sling/vest/abrestrain00      9                                                                                                     I                          Z2  9      02011010120110101        N
A4566002004control, prefabricated, includes fitting and adjustment
A4570001003Splint                                                                          Splint                      52      A                  2079                                                                               I                          D1A P      01982010120010701        N
A4575001003Topical hyperbaric oxygen chamber, disposable                                   Hyperbaric o2 chamber disps 00      935-10                                                                                                M                          D1A 9      01996010119960101        N
A4580001003Cast supplies (e. G. Plaster)                                                   Cast supplies (plaster)     00      9                  2079                                                                               I                          D1A 9      01982010120030101        N
A4590001003Special casting material (e. G. Fiberglass)                                     Special casting material    00      9                  2079                                                                               I                          D1A 9      01984010120030101        N
A4595001003Electrical stimulator supplies, 2 lead, per month, (e. G. Tens, nmes)           TENS suppl 2 lead per month 34      A45-25                                                                                                D                          D1E P      01996010120030101        N
A4600001003Sleeve for intermittent limb compression device, replacement only, each         Sleeve, inter limb comp dev 32      A                                                                                                     C                          D1E P      02007010120070101        N
A4601001003Lithium ion battery for non-prosthetic use, replacement                         Lith ion batt, non-pros use 32      A                                                                                                     C                          D1E P      02007010120070101        N
A4604001003Tubing with integrated heating element for use with positive airway pressure    Tubing with heating element 32      A                                                                                                     C                          D1E P      02006010120060101        N
A4604002004device
A4605001003Tracheal suction catheter, closed system, each                                  Trach suction cath close sys32      A                                                                                                     C                          D1E P      02005010120050101        N
A4606001003Oxygen probe for use with oximeter device, replacement                          Oxygen probe used w oximeter00      9                                                                                                     C                          D1E 9      02003010120030101        N
A4608001003Transtracheal oxygen catheter, each                                             Transtracheal oxygen cath   00      9                                                                                                     C                          D1E P      02001010120090101        N
A4611001003Battery, heavy duty; replacement for patient owned ventilator                   Heavy duty battery          32      A                                                                                                     C                          D1E P      01990010119960101        N
A4612001003Battery cables; replacement for patient-owned ventilator                        Battery cables              32      A                                                                                                     C                          D1E P      01990010119960101        N
A4613001003Battery charger; replacement for patient-owned ventilator                       Battery charger             32      A                                                                                                     C                          D1E P      01990010119960101        N
A4614001003Peak expiratory flow rate meter, hand held                                      Hand-held PEFR meter        46      A                                                                                                     C                          Z2  9      01999010119990101        N
A4615001003Cannula, nasal                                                                  Cannula nasal               00      960-4              3312                                                                               D                          D1C P      01990010120090101        N
A4616001003Tubing (oxygen), per foot                                                       Tubing (oxygen) per foot    00      960-4              3312                                                                               D                          D1C P      01990010120090101        N
A4617001003Mouth piece                                                                     Mouth piece                 00      960-4              3312                                                                               D                          D1C P      01990010120090101        N
A4618001003Breathing circuits                                                              Breathing circuits          32      A60-4              3312                                                                               D                          D1E APR    01990010119930101        N
A4619001003Face tent                                                                       Face tent                   32      A60-4              3312                                                                               D                          D1E P      01990010120110701        N
A4620001003Variable concentration mask                                                     Variable concentration mask 00      960-4              3312                                                                               D                          D1C P      01990010120090101        N
A4623001003Tracheostomy, inner cannula                                                     Tracheostomy inner cannula  37      A65-16             2130                                                                               D                          D1F P      01990010120040101        N
A4624001003Tracheal suction catheter, any type other than closed system, each              Tracheal suction tube       32      A                                                                                                     C                          D1E P      01990010120030101        N
A4625001003Tracheostomy care kit for new tracheostomy                                      Trach care kit for new trach37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A4626001003Tracheostomy cleaning brush, each                                               Tracheostomy cleaning brush 37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A4627001003Spacer, bag or reservoir, with or without mask, for use with metered dose       Spacer bag/reservoir        00      9                  2100                                                                               M                          D1A 9      01991010119970101        N
A4627002004inhaler
A4628001003Oropharyngeal suction catheter, each                                            Oropharyngeal suction cath  32      A                                                                                                     C                          D1E APR    01996010119960101        N
A4629001003Tracheostomy care kit for established tracheostomy                              Tracheostomy care kit       37      A                  2130                                                                               D                          D1F P      01996010120030101        N
A4630002003Replacement batteries,  medically necessary, transcutaneous electrical          Repl bat t.e.n.s. own by pt 32      A65-8                                                                                                 D                          D1E APR    01991010120060101        N
A4630003004stimulator, owned by patient
A4633001003Replacement bulb/lamp for ultraviolet light therapy system, each                Uvl replacement bulb        32      A                                                                                                     C                          D1E APR    02003010120030101        N
A4634001003Replacement bulb for therapeutic light box, tabletop model                      Replacement bulb th lightbox00      9                                                                                                     C                          D1E 9      02003010120030101        N
A4635001003Underarm  pad, crutch, replacement, each                                        Underarm crutch pad         32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N
A4636001003Replacement, handgrip, cane, crutch, or walker, each                            Handgrip for cane etc       32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N
A4637001003Replacement, tip, cane, crutch, walker, each.                                   Repl tip cane/crutch/walker 32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N
A4638001003Replacement battery for patient-owned ear pulse generator, each                 Repl batt pulse gen sys     32      A                                                                                                     C                          D1E P      02004010120040101        N
A4639001003Replacement pad for infrared heating pad system, each                           Infrared ht sys replcmnt pad32      A                                                                                                     C                          D1E APR    02003010120030101        N
A4640001003Replacement pad  for use with medically necessary alternating pressure pad      Alternating pressure pad    32      A60-9              4107.6                                                                             D                          D1E APR    01991010119960101        N
A4640002004owned by patient
A4641002003Radiopharmaceutical, diagnostic, not otherwise classified                       Radiopharm dx agent noc     51      A                                                                                                     C                          I1E 4      01994010120060101        N
A4642001003Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6          In111 satumomab             51      A                                                                                                     C                          I1E 4      01995010120060101        N
A4642002004millicuries
A4648001003Tissue marker, implantable, any type, each                                      Implantable tissue marker   57      A                                                                                                     C                          I1E 9S     02008010120080101        N
A4649001003Surgical supply; miscellaneous                                                  Surgical supplies           46      A                                                                                                     C                          D1A 9      01982010119980101        N
A4650004003Implantable radiation dosimeter, each                                           Implant radiation dosimeter 57      A                                                                                                     C                          I1E 9S     02008010120080101        N
A4651001003Calibrated microcapillary tube, each                                            Calibrated microcap tube    52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4652001003Microcapillary tube sealant                                                     Microcapillary tube sealant 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4653001003Peritoneal dialysis catheter anchoring device, belt, each                       PD catheter anchor belt     52      A                                                                                                     C                          P9B L      02003010120030101        N
A4657001003Syringe, with or without needle, each                                           Syringe w/wo needle         52      A                  4270                                                                               D                      0017P9B L      02002010120030101        N
A4660001003Sphygmomanometer/blood pressure apparatus with cuff and stethoscope             Sphyg/bp app w cuff and stet52      A                  4270                                                                               D                      0017P9B L      01986010120030101        N
A4663001003Blood pressure cuff only                                                        Dialysis blood pressure cuff52      A                  4270                                                                               D                      0017P9B L      01986010120030101        N
A4670001003Automatic blood pressure monitor                                                Automatic bp monitor, dial  00      950-42             4270                                                                               M                      0017P9B L      01986010120030101        N
A4671001003Disposable cycler set used with cycler dialysis machine, each                   Disposable cycler set       52      A                  4270                                                                               D                          P9B L      02004010120040101        N
A4672001003Drainage extension line, sterile, for dialysis, each                            Drainage ext line, dialysis 52      A                  4270                                                                               D                          P9B L      02004010120040101        N
A4673001003Extension line with easy lock connectors, used with dialysis                    Ext line w easy lock connect52      A                  4270                                                                               D                          P9B L      02004010120040101        N
A4674001003Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per  Chem/antisept solution, 8oz 52      A                  4270                                                                               D                          P9B L      02004010120040101        N
A46740020048 oz
A4680001003Activated carbon filter for hemodialysis, each                                  Activated carbon filter, ea 52      A55-1              4270                                                                               D                      0017P9B L      01986010120020101        N
A4690001003Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each     Dialyzer, each              52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4706001003Bicarbonate concentrate, solution, for hemodialysis, per gallon                 Bicarbonate conc sol per gal52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4707001003Bicarbonate concentrate, powder, for hemodialysis, per packet                   Bicarbonate conc pow per pac52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4708001003Acetate concentrate solution, for hemodialysis, per gallon                      Acetate conc sol per gallon 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4709001003Acid concentrate, solution, for hemodialysis, per gallon                        Acid conc sol per gallon    52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4714001003Treated water (deionized, distilled, or reverse osmosis) for peritoneal         Treated water per gallon    52      A55-1              4270                                                                               D                      0017P9B L      01986010120020101        N
A4714002004dialysis, per gallon
A4719001003"y set" tubing for peritoneal dialysis                                          "Y set" tubing              52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4720001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialysat sol fld vol > 249cc52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4720002004249cc, but less than or equal to 999cc, for peritoneal dialysis
A4721001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialysat sol fld vol > 999cc52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4721002004999cc but less than or equal to 1999cc, for peritoneal dialysis
A4722001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 1999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A47220020041999cc but less than or equal to 2999cc, for peritoneal dialysis
A4723001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 2999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A47230020042999cc but less than or equal to 3999cc, for peritoneal dialysis
A4724001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 3999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A47240020043999cc but less than or equal to 4999cc, for peritoneal dialysis
A4725001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 4999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A47250020044999cc but less than or equal to 5999cc, for peritoneal dialysis
A4726001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 5999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A47260020045999cc, for peritoneal dialysis
A4728001003Dialysate solution, non-dextrose containing, 500 ml                             Dialysate solution, non-dex 52      A                                                                                                     C                          P9B L      02004010120040101        N
A4730001003Fistula cannulation set for hemodialysis, each                                  Fistula cannulation set, ea 52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4736001003Topical anesthetic, for dialysis, per gram                                      Topical anesthetic, per gram52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4737001003Injectable anesthetic, for dialysis, per 10 ml                                  Inj anesthetic per 10 ml    52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4740001003Shunt accessory, for hemodialysis, any type, each                               Shunt accessory             52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4750001003Blood tubing, arterial or venous, for hemodialysis, each                        Art or venous blood tubing  52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4755001003Blood tubing, arterial and venous combined, for hemodialysis, each              Comb art/venous blood tubing52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4760001003Dialysate solution test kit, for peritoneal dialysis, any type, each            Dialysate sol test kit, each52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4765001003Dialysate concentrate, powder, additive for peritoneal dialysis, per packet     Dialysate conc pow per pack 52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4766001003Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml    Dialysate conc sol add 10 ml52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4770001003Blood collection tube, vacuum, for dialysis, per 50                             Blood collection tube/vacuum52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4771001003Serum clotting time tube, for dialysis, per 50                                  Serum clotting time tube    52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4772001003Blood glucose test strips, for dialysis, per 50                                 Blood glucose test strips   52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4773001003Occult blood test strips, for dialysis, per 50                                  Occult blood test strips    52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4774001003Ammonia test strips, for dialysis, per 50                                       Ammonia test strips         52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4802001003Protamine sulfate, for hemodialysis, per 50 mg                                  Protamine sulfate per 50 mg 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N
A4860001003Disposable catheter tips for peritoneal dialysis, per 10                        Disposable catheter tips    52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4870001003Plumbing and/or electrical work for home hemodialysis equipment                 Plumb/elec wk hm hemo equip 52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N
A4890001003Contracts, repair and maintenance, for hemodialysis equipment                   Repair/maint cont hemo equip52      A                  2100.4                                                                             D                      0017P9B L      01986010120020101        N
A4911001003Drain bag/bottle, for dialysis, each                                            Drain bag/bottle            52      A                                                                                                     D                      0017P9B L      02002010120020101        N
A4913001003Miscellaneous dialysis supplies, not otherwise specified                        Misc dialysis supplies noc  52      A                                                                                                     D                      0017P9B L      01986010120020101        N
A4918001003Venous pressure clamp, for hemodialysis, each                                   Venous pressure clamp       52      A                                                                                                     D                      0017P9B L      01986010120020101        N
A4927001003Gloves, non-sterile, per 100                                                    Non-sterile gloves          52      A                                                                                                     D                      0017P9B L      01986010120030101        N
A4928001003Surgical mask, per 20                                                           Surgical mask               52      A                                                                                                     D                      0017P9B L      02002010120030101        N
A4929001003Tourniquet for dialysis, each                                                   Tourniquet for dialysis, ea 52      A                                                                                                     D                      0017P9B L      02002010120020101        N
A4930001003Gloves, sterile, per pair                                                       Sterile, gloves per pair    52      A                                                                                                     D                      0017P9B L      02003010120030101        N
A4931001003Oral thermometer, reusable, any type, each                                      Reusable oral thermometer   52      A                                                                                                     C                          P9B L      02003010120030101        N
A4932001003Rectal thermometer, reusable, any type, each                                    Reusable rectal thermometer 00      9                                                                                                     C                          Z2  9      02003010120070101        N
A5051002003Ostomy pouch, closed; with barrier attached (1 piece), each                     Pouch clsd w barr attached  37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5052001003Ostomy pouch, closed; without barrier attached (1 piece), each                  Clsd ostomy pouch w/o barr  37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5053001003Ostomy pouch, closed; for use on faceplate, each                                Clsd ostomy pouch faceplate 37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5054001003Ostomy pouch, closed; for use on barrier with flange (2 piece), each            Clsd ostomy pouch w/flange  37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5055001003Stoma cap                                                                       Stoma cap                   37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A5056001003Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1   1 pc ost pouch w filter     37      A                  2130                                                                               D                          D1F P      02012010120120101        N
A5056002004piece), each
A5057001003Ostomy pouch, drainable, with extended wear barrier attached, with built in     1 pc ost pou w built-in conv37      A                  2130                                                                               D                          D1F P      02012010120120101        N
A5057002004convexity, with filter, (1 piece), each
A5061001003Ostomy pouch, drainable; with barrier attached, (1 piece), each                 Pouch drainable w barrier at37      A                                                                                                     C                          D1F P      01990010120030101        N
A5062001003Ostomy pouch, drainable; without barrier attached (1 piece), each               Drnble ostomy pouch w/o barr37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5063001003Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each  Drain ostomy pouch w/flange 37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5071001003Ostomy pouch, urinary; with barrier attached (1 piece), each                    Urinary pouch w/barrier     37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5072001003Ostomy pouch, urinary; without barrier attached (1 piece), each                 Urinary pouch w/o barrier   37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5073001003Ostomy pouch, urinary; for use on barrier with flange (2 piece), each           Urinary pouch on barr w/flng37      A                  2130                                                                               D                          D1F P      01990010120030101        N
A5081001003Continent device; plug for continent stoma                                      Continent stoma plug        37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A5082001003Continent device; catheter for continent stoma                                  Continent stoma catheter    37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A5083001003Continent device, stoma absorptive cover for continent stoma                    Stoma absorptive cover      37      A                                                                                                     C                          D1F P      02008010120080101        N
A5093001003Ostomy accessory; convex insert                                                 Ostomy accessory convex inse37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A5102002003Bedside drainage bottle with or without tubing, rigid or expandable, each       Bedside drain btl w/wo tube 37      A                  2130                                                                               D                          D1F P      01990010119970101        N
A5105001003Urinary suspensory with leg bag, with or without tube, each                     Urinary suspensory          37      A                  2130                                                                               D                          D1F P      01990010120080101        N
A5112001003Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, Urinary leg bag             37      A                  2130                                                                               D                          D1F P      01990010120110101        N
A5112002004each
A5113001003Leg strap; latex, replacement only, per set                                     Latex leg strap             37      A                  2130                                                                               D                          D1F P      01990010119980101        N
A5114001003Leg strap; foam or fabric,  replacement only, per set                           Foam/fabric leg strap       37      A                  2130                                                                               D                          D1F P      01990010119980101        N
A5120001003Skin barrier, wipes or swabs, each                                              Skin barrier, wipe or swab  37      A                  2130                                                                               D                          D1F P      02006010120060101        N
A5121001003Skin barrier; solid, 6 x 6 or equivalent, each                                  Solid skin barrier 6x6      37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A5122001003Skin barrier; solid, 8 x 8 or equivalent, each                                  Solid skin barrier 8x8      37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A5126001003Adhesive or non-adhesive;  disk or foam pad                                     Disk/foam pad +or- adhesive 37      A                  2130                                                                               D                          D1F P      01990010120000101        N
A5131001003Appliance cleaner, incontinence and ostomy appliances, per 16 oz.               Appliance cleaner           37      A                  2130                                                                               D                          D1F P      01990010119900101        N
A5200001003Percutaneous catheter/tube anchoring device, adhesive skin attachment           Percutaneous catheter anchor37      A                  2130                                                                               D                          D1F P      01999010120030101        N
A5500002003For diabetics only, fitting (including follow-up), custom preparation and       Diab shoe for density insert38      A                  2134                                                                               D                          D1F J      01995010120050101        N
A5500003004supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-
A5500004004density insert(s), per shoe
A5501001003For diabetics only, fitting (including follow-up), custom preparation and       Diabetic custom molded shoe 38      A                  2134                                                                               D                          D1F J      01995010120050101        N
A5501002004supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per
A5501003004shoe
A5503001003For diabetics only, modification (including fitting) of off-the-shelf           Diabetic shoe w/roller/rockr38      A                  2134                                                                               D                          D1F J      01995010120050101        N
A5503002004depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per
A5503003004shoe
A5504001003For diabetics only, modification (including fitting) of off-the-shelf           Diabetic shoe with wedge    38      A                  2134                                                                               D                          D1F J      01995010120050101        N
A5504002004depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
A5505001003For diabetics only, modification (including fitting) of off-the-shelf           Diab shoe w/metatarsal bar  38      A                  2134                                                                               D                          D1F J      01995010120050101        N
A5505002004depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
A5506001003For diabetics only, modification (including fitting) of off-the-shelf           Diabetic shoe w/off set heel38      A                  2134                                                                               D                          D1F J      01995010120050101        N
A5506002004depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
A5507001003For diabetics only, not otherwise specified modification (including fitting) of Modification diabetic shoe  38      A                  2134                                                                               D                          D1F J      01995010120050101        N
A5507002004off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5508001003For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or         Diabetic deluxe shoe        38      A                  2134                                                                               D                          D1F J      02000010120050101        N
A5508002004custom-molded shoe, per shoe
A5510001003For diabetics only, direct formed, compression molded to patient's foot without Compression form shoe insert38      A                  2134                                                                               D                          D1F J      02002010120050101        N
A5510002004external heat source, multiple-density insert(s) prefabricated, per shoe
A5512001003For diabetics only, multiple density insert, direct formed, molded to foot      Multi den insert direct form38      A                                                                                                     C                          D1F J      02006010120100101        N
A5512002004after external heat source of 230 degrees fahrenheit or higher, total contact
A5512003004with patient's foot, including arch, base layer minimum of 1/4 inch material of
A5512004004shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher),
A5512005004prefabricated, each
A5513001003For diabetics only, multiple density insert, custom molded from model of        Multi den insert custom mold38      A                                                                                                     C                          D1F J      02006010120100101        N
A5513002004patient's foot, total contact with patient's foot, including arch, base layer
A5513003004minimum of 3/16 inch material of shore a 35 durometer or higher), includes arch
A5513004004filler and other shaping material, custom fabricated, each
A6000001003Non-contact wound warming wound cover for use with the non-contact wound        Wound warming wound cover   00      9                  2303                                                                               M                          D1E P      02002010120020701        N
A6000002004warming device and warming card
A6010001003Collagen based wound filler, dry form, sterile, per gram of collagen            Collagen based wound filler 35      A                  2079                                                                               D                          D1A S      02002010120090101        N
A6011001003Collagen based wound filler, gel/paste, per gram of collagen                    Collagen gel/paste wound fil35      A                  2079                                                                               D                          D1A S      02003010120110101        N
A6021001003Collagen dressing, sterile, size 16 sq. In. Or less, each                       Collagen dressing <=16 sq in35      A                  2079                                                                               D                          D1A S      02001010120130101        C
A6022001003Collagen dressing, sterile, size more than 16 sq. In. But less than or equal to Collagen drsg>16<=48 sq in  35      A                  2079                                                                               D                          D1A S      02001010120130101        C
A602200200448 sq. In. , each
A6023001003Collagen dressing, sterile, size more than 48 sq. In. , each                    Collagen dressing >48 sq in 35      A                  2079                                                                               D                          D1A S      02001010120130101        C
A6024001003Collagen dressing wound filler, sterile, per 6 inches                           Collagen dsg wound filler   35      A                  2079                                                                               D                          D1A S      02001010120090101        N
A6025001003Gel sheet for dermal or epidermal application, (e. G. , silicone, hydrogel,     Silicone gel sheet, each    00      9                                                                                                     C                          D1A 9      01997010120070101        N
A6025002004other), each
A6154001003Wound pouch, each                                                               Wound pouch each            35      A                  2079                                                                               D                          D1A S      01997010120030101        N
A6196001003Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. Alginate dressing <=16 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6196002004In. Or less, each dressing
A6197001003Alginate or other fiber gelling dressing, wound cover, sterile, pad size more   Alginate drsg >16 <=48 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6197002004than 16 sq. In. But less than or equal to 48 sq. In. , each dressing
A6198001003Alginate or other fiber gelling dressing, wound cover, sterile, pad size more   alginate dressing > 48 sq in46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6198002004than 48 sq. In. , each dressing
A6199001003Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches   Alginate drsg wound filler  35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6200001003Composite dressing, pad size 16 sq. In. Or less, without adhesive border, each  Compos drsg <=16 no border  00      9                                                                                                     I                          D1A S      0199901012010010120091231N
A6200002004dressing
A6201001003Composite dressing, pad size more than 16 sq. In. But less than or equal to 48  Compos drsg >16<=48 no bdr  00      9                                                                                                     I                          D1A S      0199901012010010120091231N
A6201002004sq. In. , without adhesive border, each dressing
A6202001003Composite dressing, pad size more than 48 sq. In. , without adhesive border,    Compos drsg >48 no border   00      9                                                                                                     I                          D1A S      0199901012010010120091231N
A6202002004each dressing
A6203001003Composite dressing, sterile, pad size 16 sq. In. Or less, with any size         Composite drsg <= 16 sq in  35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6203002004adhesive border, each dressing
A6204001003Composite dressing, sterile, pad size more than 16 sq. In. But less than or     Composite drsg >16<=48 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6204002004equal to 48 sq. In. , with any size adhesive border, each dressing
A6205001003Composite dressing, sterile, pad size more than 48 sq. In. , with any size      Composite drsg > 48 sq in   46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6205002004adhesive border, each dressing
A6206001003Contact layer, sterile, 16 sq. In. Or less, each dressing                       Contact layer <= 16 sq in   46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6207001003Contact layer, sterile, more than 16 sq. In. But less than or equal to 48 sq.   Contact layer >16<= 48 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6207002004In. , each dressing
A6208001003Contact layer, sterile, more than 48 sq. In. , each dressing                    Contact layer > 48 sq in    46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6209001003Foam dressing, wound cover, sterile, pad size 16 sq. In. Or less, without       Foam drsg <=16 sq in w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6209002004adhesive border, each dressing
A6210001003Foam dressing, wound cover, sterile, pad size more than 16 sq. In. But less     Foam drg >16<=48 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6210002004than or equal to 48 sq. In. , without adhesive border, each dressing
A6211001003Foam dressing, wound cover, sterile, pad size more than 48 sq. In. , without    Foam drg > 48 sq in w/o brdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6211002004adhesive border, each dressing
A6212001003Foam dressing, wound cover, sterile, pad size 16 sq. In. Or less, with any size Foam drg <=16 sq in w/border35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6212002004adhesive border, each dressing
A6213001003Foam dressing, wound cover, sterile, pad size more than 16 sq. In. But less     Foam drg >16<=48 sq in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6213002004than or equal to 48 sq. In. , with any size adhesive border, each dressing
A6214001003Foam dressing, wound cover, sterile, pad size more than 48 sq. In. , with any   Foam drg > 48 sq in w/border35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6214002004size adhesive border, each dressing
A6215001003Foam dressing, wound filler, sterile, per gram                                  Foam dressing wound filler  46      A                  2079                                                                               D                          D1A LS     01997010120090101        N
A6216001003Gauze, non-impregnated, non-sterile, pad size 16 sq. In. Or less, without       Non-sterile gauze<=16 sq in 35      A                  2079                                                                               D                          D1A S      01997010120030101        N
A6216002004adhesive border, each dressing
A6217001003Gauze, non-impregnated, non-sterile, pad size more than 16 sq. In. But less     Non-sterile gauze>16<=48 sq 35      A                  2079                                                                               D                          D1A S      01997010120030101        N
A6217002004than or equal to 48 sq. In. , without adhesive border, each dressing
A6218001003Gauze, non-impregnated, non-sterile, pad size more than 48 sq. In. , without    Non-sterile gauze > 48 sq in46      A                  2079                                                                               D                          D1A S      01997010120030101        N
A6218002004adhesive border, each dressing
A6219001003Gauze, non-impregnated, sterile, pad size 16 sq. In. Or less, with any size     Gauze <= 16 sq in w/border  35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6219002004adhesive border, each dressing
A6220001003Gauze, non-impregnated, sterile, pad size more than 16 sq. In. But less than or Gauze >16 <=48 sq in w/bordr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6220002004equal to 48 sq. In. , with any size adhesive border, each dressing
A6221001003Gauze, non-impregnated, sterile, pad size more than 48 sq. In. , with any size  Gauze > 48 sq in w/border   46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6221002004adhesive border, each dressing
A6222001003Gauze, impregnated with other than water, normal saline, or hydrogel, sterile,  Gauze <=16 in no w/sal w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6222002004pad size 16 sq. In. Or less, without adhesive border, each dressing
A6223001003Gauze, impregnated with other than water, normal saline, or hydrogel, sterile,  Gauze >16<=48 no w/sal w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6223002004pad size more than 16 sq. In. , but less than or equal to 48 sq. In. , without
A6223003004adhesive border, each dressing
A6224001003Gauze, impregnated with other than water, normal saline, or hydrogel, sterile,  Gauze > 48 in no w/sal w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6224002004pad size more than 48 sq. In. , without adhesive border, each dressing
A6228001003Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. In. Or     Gauze <= 16 sq in water/sal 46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6228002004less, without adhesive border, each dressing
A6229001003Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq.  Gauze >16<=48 sq in watr/sal35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6229002004In. But less than or equal to 48 sq. In. , without adhesive border, each
A6229003004dressing
A6230001003Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq.  Gauze > 48 sq in water/salne46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6230002004In. , without adhesive border, each dressing
A6231001003Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16    Hydrogel dsg<=16 sq in      35      A                  2079                                                                               D                          D1A S      02001010120090101        N
A6231002004sq. In. Or less, each dressing
A6232001003Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size       Hydrogel dsg>16<=48 sq in   35      A                  2079                                                                               D                          D1A S      02001010120090101        N
A6232002004greater than 16 sq. In. , but less than or equal to 48 sq. In. , each dressing
A6233001003Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more  Hydrogel dressing >48 sq in 35      A                  2079                                                                               D                          D1A S      02001010120090101        N
A6233002004than 48 sq. In. , each dressing
A6234001003Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. In. Or less,       Hydrocolld drg <=16 w/o bdr 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6234002004without adhesive border, each dressing
A6235001003Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. In. But  Hydrocolld drg >16<=48 w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6235002004less than or equal to 48 sq. In. , without adhesive border, each dressing
A6236001003Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. In. ,    Hydrocolld drg > 48 in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6236002004without adhesive border, each dressing
A6237001003Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. In. Or less, with  Hydrocolld drg <=16 in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6237002004any size adhesive border, each dressing
A6238001003Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. In. But  Hydrocolld drg >16<=48 w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6238002004less than or equal to 48 sq. In. , with any size adhesive border, each dressing
A6239001003Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. In. ,    Hydrocolld drg > 48 in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6239002004with any size adhesive border, each dressing
A6240001003Hydrocolloid dressing, wound filler, paste, sterile, per ounce                  Hydrocolld drg filler paste 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6241001003Hydrocolloid dressing, wound filler, dry form, sterile, per gram                Hydrocolloid drg filler dry 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6242001003Hydrogel dressing, wound cover, sterile, pad size 16 sq. In. Or less, without   Hydrogel drg <=16 in w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6242002004adhesive border, each dressing
A6243001003Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. In. But less Hydrogel drg >16<=48 w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6243002004than or equal to 48 sq. In. , without adhesive border, each dressing
A6244001003Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. In. ,        Hydrogel drg >48 in w/o bdr 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6244002004without adhesive border, each dressing
A6245001003Hydrogel dressing, wound cover, sterile, pad size 16 sq. In. Or less, with any  Hydrogel drg <= 16 in w/bdr 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6245002004size adhesive border, each dressing
A6246001003Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. In. But less Hydrogel drg >16<=48 in w/b 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6246002004than or equal to 48 sq. In. , with any size adhesive border, each dressing
A6247001003Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. In. , with   Hydrogel drg > 48 sq in w/b 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6247002004any size adhesive border, each dressing
A6248001003Hydrogel dressing, wound filler, gel, per fluid ounce                           Hydrogel drsg gel filler    35      A                  2079                                                                               D                          D1A S      01997010120110101        N
A6250001003Skin sealants, protectants, moisturizers, ointments, any type, any size         Skin seal protect moisturizr00      9                  2079                                                                               D                          D1A LS     01997010120030101        N
A6251001003Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. In. Or     Absorpt drg <=16 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6251002004less, without adhesive border, each dressing
A6252001003Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq.  Absorpt drg >16 <=48 w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6252002004In. But less than or equal to 48 sq. In. , without adhesive border, each
A6252003004dressing
A6253001003Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq.  Absorpt drg > 48 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6253002004In. , without adhesive border, each dressing
A6254001003Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. In. Or     Absorpt drg <=16 sq in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6254002004less, with any size adhesive border, each dressing
A6255001003Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq.  Absorpt drg >16<=48 in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6255002004In. But less than or equal to 48 sq. In. , with any size adhesive border, each
A6255003004dressing
A6256001003Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq.  Absorpt drg > 48 sq in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6256002004In. , with any size adhesive border, each dressing
A6257001003Transparent film, sterile, 16 sq. In. Or less, each dressing                    Transparent film <= 16 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6258001003Transparent film, sterile, more than 16 sq. In. But less than or equal to 48    Transparent film >16<=48 in 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6258002004sq. In. , each dressing
A6259001003Transparent film, sterile, more than 48 sq. In. , each dressing                 Transparent film > 48 sq in 35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6260001003Wound cleansers, any type, any size                                             Wound cleanser any type/size00      9                  2079                                                                               D                          D1A LS     01997010120110101        N
A6261001003Wound filler,  gel/paste, per fluid ounce, not otherwise specified              Wound filler gel/paste /oz  46      A                  2079                                                                               D                          D1A S      01997010120110101        N
A6262001003Wound filler, dry form, per gram,  not otherwise specified                      Wound filler dry form / gram46      A                  2079                                                                               D                          D1A S      01997010120110101        N
A6266001003Gauze, impregnated, other than water, normal saline, or zinc paste, sterile,    Impreg gauze no h20/sal/yard35      A                  2079                                                                               D                          D1A S      01997010120090101        N
A6266002004any width, per linear yard
A6402001003Gauze, non-impregnated, sterile, pad size 16 sq. In. Or less, without adhesive  Sterile gauze <= 16 sq in   35      A                  2079                                                                               D                          D1A LS     01997010120060101        N
A6402002004border, each dressing
A6403001003Gauze, non-impregnated, sterile, pad size more than 16 sq. In. Less than or     Sterile gauze>16 <= 48 sq in35      A                  2079                                                                               D                          D1A S      01997010120030101        N
A6403002004equal to 48 sq. In. , without adhesive border, each dressing
A6404001003Gauze, non-impregnated, sterile, pad size more than 48 sq. In. , without        Sterile gauze > 48 sq in    35      A                  2079                                                                               D                          D1A S      01997010120030101        N
A6404002004adhesive border, each dressing
A6407001003Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear   Packing strips, non-impreg  35      A                                                                                                     C                          D1A S      02004010120090101        N
A6407002004yard
A6410001003Eye pad, sterile, each                                                          Sterile eye pad             35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6411001003Eye pad, non-sterile, each                                                      Non-sterile eye pad         35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6412001003Eye patch, occlusive, each                                                      Occlusive eye patch         00      9                                                                                                     C                          Z2  S      02003010120070101        N
A6413001003Adhesive bandage, first-aid type, any size, each                                Adhesive bandage, first-aid 00      9                                          1861(s)(5)                                                 S                          D1A P      02008010120080101        N
A6441001003Padding bandage, non-elastic, non-woven/non-knitted, width greater than or      Pad band w>=3" <5"/yd       35      A                                                                                                     C                          D1A S      02004010120040101        N
A6441002004equal to three inches and less than five inches, per yard
A6442001003Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than    Conform band n/s w<3"/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N
A6442002004three inches, per yard
A6443001003Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than Conform band n/s w>=3"<5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N
A6443002004or equal to three inches and less than five inches, per yard
A6444001003Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than Conform band n/s w>=5"/yd   35      A                                                                                                     C                          D1A S      02004010120040101        N
A6444002004or equal to 5 inches, per yard
A6445001003Conforming bandage, non-elastic, knitted/woven, sterile, width less than three  Conform band s w <3"/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N
A6445002004inches, per yard
A6446001003Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or  Conform band s w>=3" <5"/yd 35      A                                                                                                     C                          D1A S      02004010120040101        N
A6446002004equal to three inches and less than five inches, per yard
A6447001003Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or  Conform band s w >=5"/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N
A6447002004equal to five inches, per yard
A6448001003Light compression bandage, elastic, knitted/woven, width less than three        Lt compres band <3"/yd      35      A                                                                                                     C                          D1A S      02004010120040101        N
A6448002004inches, per yard
A6449001003Light compression bandage, elastic, knitted/woven, width greater than or equal  Lt compres band >=3" <5"/yd 35      A                                                                                                     C                          D1A S      02004010120040101        N
A6449002004to three inches and less than five inches, per yard
A6450001003Light compression bandage, elastic, knitted/woven, width greater than or equal  Lt compres band >=5"/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N
A6450002004to five inches, per yard
A6451001003Moderate compression bandage, elastic, knitted/woven, load resistance of 1. 25  Mod compres band w>=3"<5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N
A6451002004to 1. 34 foot pounds at 50% maximum stretch, width greater than or equal to
A6451003004three inches and less than five inches, per yard
A6452001003High compression bandage, elastic, knitted/woven, load resistance greater than  High compres band w>=3"<5"yd35      A                                                                                                     C                          D1A S      02004010120040101        N
A6452002004or equal to 1. 35 foot pounds at 50% maximum stretch, width greater than or
A6452003004equal to three inches and less than five inches, per yard
A6453001003Self-adherent bandage, elastic, non-knitted/non-woven, width less than three    Self-adher band w <3"/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N
A6453002004inches, per yard
A6454001003Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or    Self-adher band w>=3" <5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N
A6454002004equal to three inches and less than five inches, per yard
A6455001003Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or    Self-adher band >=5"/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N
A6455002004equal to five inches, per yard
A6456001003Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than  Zinc paste band w >=3"<5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N
A6456002004or equal to three inches and less than five inches, per yard
A6457001003Tubular dressing with or without elastic, any width, per linear yard            Tubular dressing            35      A                                                                                                     C                          D1A S      02006010120060101        N
A6501001003Compression burn garment, bodysuit (head to foot), custom fabricated            Compres burngarment bodysuit35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6502001003Compression burn garment, chin strap, custom fabricated                         Compres burngarment chinstrp35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6503001003Compression burn garment, facial hood, custom fabricated                        Compres burngarment facehood35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6504001003Compression burn garment, glove to wrist, custom fabricated                     Cmprsburngarment glove-wrist35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6505001003Compression burn garment, glove to elbow, custom fabricated                     Cmprsburngarment glove-elbow35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6506001003Compression burn garment, glove to axilla, custom fabricated                    Cmprsburngrmnt glove-axilla 35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6507001003Compression burn garment, foot to knee length, custom fabricated                Cmprs burngarment foot-knee 35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6508001003Compression burn garment, foot to thigh length, custom fabricated               Cmprs burngarment foot-thigh35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6509001003Compression burn garment, upper trunk to waist including arm openings (vest),   Compres burn garment jacket 35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6509002004custom fabricated
A6510001003Compression burn garment, trunk, including arms down to leg openings (leotard), Compres burn garment leotard35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6510002004custom fabricated
A6511001003Compression burn garment, lower trunk including leg openings (panty), custom    Compres burn garment panty  35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6511002004fabricated
A6512001003Compression burn garment, not otherwise classified                              Compres burn garment, noc   35      A                  2079                                                                               D                          D1A S      02003010120030101        N
A6513001003Compression burn mask, face and/or neck, plastic or equal, custom fabricated    Compress burn mask face/neck00      9                                                                                                     C                          D1A P      02006010120060101        N
A6530001003Gradient compression stocking, below knee, 18-30 mmhg, each                     Compression stocking BK18-3000      960-9                                                                                                 M                      0072D1A P      02006010120110101        N
A6531001003Gradient compression stocking, below knee, 30-40 mmhg, each                     Compression stocking BK30-4035      A                  2079                                                                               D                      0072D1A PS     02006010120060101        N
A6532001003Gradient compression stocking, below knee, 40-50 mmhg, each                     Compression stocking BK40-5035      A                  2079                                                                               D                      0072D1A PS     02006010120060101        N
A6533001003Gradient compression stocking, thigh length, 18-30 mmhg, each                   Gc stocking thighlngth 18-3000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6534001003Gradient compression stocking, thigh length, 30-40 mmhg, each                   Gc stocking thighlngth 30-4000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6535001003Gradient compression stocking, thigh length, 40-50 mmhg, each                   Gc stocking thighlngth 40-5000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6536001003Gradient compression stocking, full length/chap style, 18-30 mmhg, each         Gc stocking full lngth 18-3000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6537001003Gradient compression stocking, full length/chap style, 30-40 mmhg, each         Gc stocking full lngth 30-4000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6538001003Gradient compression stocking, full length/chap style, 40-50 mmhg, each         Gc stocking full lngth 40-5000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6539001003Gradient compression stocking, waist length, 18-30 mmhg, each                   Gc stocking waistlngth 18-3000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6540001003Gradient compression stocking, waist length, 30-40 mmhg, each                   Gc stocking waistlngth 30-4000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6541001003Gradient compression stocking, waist length, 40-50 mmhg, each                   Gc stocking waistlngth 40-5000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6542001003Gradient compression stocking, custom made                                      Gc stocking custom made     00      960-9              2133                                                                               M                      0072D1F P      0200601012010010120091231N
A6543001003Gradient compression stocking, lymphedema                                       Gc stocking lymphedema      00      960-9              2133                                                                               M                      0072D1F P      0200601012010010120091231N
A6544001003Gradient compression stocking, garter belt                                      Gc stocking garter belt     00      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6545001003Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each           Grad comp non-elastic BK    35      A                  2079                                                                               D                          D1A PS     02009010120110101        N
A6549001003Gradient compression stocking/sleeve, not otherwise specified                   G compression stocking      00      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N
A6550001003Wound care set, for negative pressure wound therapy electrical pump, includes   Neg pres wound ther drsg set34      A                                                                                                     C                          D1E P      02004010120060101        N
A6550002004all supplies and accessories
A7000001003Canister, disposable, used with suction pump, each                              Disposable canister for pump32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7001001003Canister, non-disposable, used with suction pump, each                          Nondisposable pump canister 32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7002001003Tubing, used with suction pump, each                                            Tubing used w suction pump  32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7003001003Administration set, with small volume nonfiltered pneumatic nebulizer,          Nebulizer administration set32      A                                                                                                     C                          D1E P      02000010120000101        N
A7003002004disposable
A7004001003Small volume nonfiltered pneumatic nebulizer, disposable                        Disposable nebulizer sml vol32      A                                                                                                     C                          D1E P      02000010120000101        N
A7005001003Administration set, with small volume nonfiltered pneumatic nebulizer,          Nondisposable nebulizer set 32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7005002004non-disposable
A7006001003Administration set, with small volume filtered pneumatic nebulizer              Filtered nebulizer admin set32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7007001003Large volume nebulizer, disposable, unfilled, used with aerosol compressor      Lg vol nebulizer disposable 32      A                                                                                                     C                          D1E P      02000010120000101        N
A7008001003Large volume nebulizer, disposable, prefilled, used with aerosol compressor     Disposable nebulizer prefill32      A                                                                                                     C                          D1E P      02000010120000101        N
A7009001003Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer   Nebulizer reservoir bottle  32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7010001003Corrugated tubing, disposable, used with large volume nebulizer, 100 feet       Disposable corrugated tubing32      A                                                                                                     C                          D1E P      02000010120000101        N
A7011001003Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet    Nondispos corrugated tubing 46      A                                                                                                     C                          D1E P      02000010120000101        N
A7012001003Water collection device, used with large volume nebulizer                       Nebulizer water collec devic32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7013001003Filter, disposable, used with aerosol compressor or ultrasonic generator        Disposable compressor filter32      A                                                                                                     C                          D1E P      02000010120110101        N
A7014001003Filter, nondisposable, used with aerosol compressor or ultrasonic generator     Compressor nondispos filter 32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7015001003Aerosol mask, used with dme nebulizer                                           Aerosol mask used w nebulize32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7016001003Dome and mouthpiece, used with small volume ultrasonic nebulizer                Nebulizer dome & mouthpiece 32      A                                                                                                     C                          D1E APR    02000010120000101        N
A7017001003Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with   Nebulizer not used w oxygen 32      A60-9                                                                                                 D                          D1E APR    02000010120000101        N
A7017002004oxygen
A7018001003Water, distilled, used with large volume nebulizer, 1000 ml                     Water distilled w/nebulizer 32      A                                                                                                     C                          D1E P      02001010120010101        N
A7020001003Interface for cough stimulating device, includes all components, replacement    Interface, cough stim device32      A                                                                                                     C                          D1E R      02011010120110101        N
A7020002004only
A7025001003High frequency chest wall oscillation system vest, replacement for use with     Replace chest compress vest 32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7025002004patient owned equipment, each
A7026001003High frequency chest wall oscillation system hose, replacement for use with     Replace chst cmprss sys hose32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7026002004patient owned equipment, each
A7027001003Combination oral/nasal mask, used with continuous positive airway pressure      Combination oral/nasal mask 32      A                                                                                                     C                          D1E APR    02008010120080101        N
A7027002004device, each
A7028001003Oral cushion for combination oral/nasal mask, replacement only, each            Repl oral cushion combo mask32      A                                                                                                     C                          D1E APR    02008010120080101        N
A7029001003Nasal pillows for combination oral/nasal mask, replacement only, pair           Repl nasal pillow comb mask 32      A                                                                                                     C                          D1E APR    02008010120080101        N
A7030001003Full face mask used with positive airway pressure device, each                  CPAP full face mask         32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7031001003Face mask interface, replacement for full face mask, each                       Replacement facemask interfa32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7032001003Cushion for use on nasal mask interface, replacement only, each                 Replacement nasal cushion   32      A                                                                                                     C                          D1E APR    02003010120060101        N
A7033001003Pillow for use on nasal cannula type interface, replacement only, pair          Replacement nasal pillows   32      A                                                                                                     C                          D1E APR    02003010120060101        N
A7034001003Nasal interface (mask or cannula type) used with positive airway pressure       Nasal application device    32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7034002004device, with or without head strap
A7035001003Headgear used with positive airway pressure device                              Pos airway press headgear   32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7036001003Chinstrap used with positive airway pressure device                             Pos airway press chinstrap  32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7037001003Tubing used with positive airway pressure device                                Pos airway pressure tubing  32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7038001003Filter, disposable, used with positive airway pressure device                   Pos airway pressure filter  32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7039001003Filter, non disposable, used with positive airway pressure device               Filter, non disposable w pap32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7040001003One way chest drain valve                                                       One way chest drain valve   38      A                                                                                                     C                          D1F P      02005010120050101        N
A7041001003Water seal drainage container and tubing for use with implanted chest tube      Water seal drain container  38      A                                                                                                     C                          D1F P      02005010120050101        N
A7042001003Implanted pleural catheter, each                                                Implanted pleural catheter  38      A                                                                                                     C                          D1F P      02003010120030101        N
A7043001003Vacuum drainage bottle and tubing for use with implanted catheter               Vacuum drainagebottle/tubing38      A                                                                                                     C                          D1F P      02003010120030101        N
A7044001003Oral interface used with positive airway pressure device, each                  PAP oral interface          32      A                                                                                                     C                          D1E APR    02003010120030101        N
A7045001003Exhalation port with or without swivel used with accessories for positive       Repl exhalation port for PAP32      A60-17                                                                                                D                          D1E APR    02005010120050101        N
A7045002004airway devices, replacement only
A7046001003Water chamber for humidifier, used with positive airway pressure device,        Repl water chamber, PAP dev 32      A60-17                                                                                                D                          D1E P      02004010120040101        N
A7046002004replacement, each
A7501001003Tracheostoma valve, including diaphragm, each                                   Tracheostoma valve w diaphra37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7502001003Replacement diaphragm/faceplate for tracheostoma valve, each                    Replacement diaphragm/fplate37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7503001003Filter holder or filter cap, reusable, for use in a tracheostoma heat and       HMES filter holder or cap   37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7503002004moisture exchange system, each
A7504001003Filter for use in a tracheostoma heat and moisture exchange system, each        Tracheostoma HMES filter    37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7505001003Housing, reusable without adhesive, for use in a heat and moisture exchange     HMES or trach valve housing 37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7505002004system and/or with a tracheostoma valve, each
A7506001003Adhesive disc for use in a heat and moisture exchange system and/or with        HMES/trachvalve adhesivedisk37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7506002004tracheostoma valve, any type each
A7507001003Filter holder and integrated filter without adhesive, for use in a tracheostoma Integrated filter & holder  37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7507002004heat and moisture exchange system, each
A7508001003Housing and integrated adhesive, for use in a tracheostoma heat and moisture    Housing & Integrated Adhesiv37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7508002004exchange system and/or with a tracheostoma valve, each
A7509001003Filter holder and integrated filter housing, and adhesive, for use as a         Heat & moisture exchange sys37      A                  2130                                                                               D                          D1F P      02001010120010101        N
A7509002004tracheostoma heat and moisture exchange system, each
A7520001003Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone   Trach/laryn tube non-cuffed 37      A                                                                                                     C                          D1F P      02004010120040101        N
A7520002004or equal, each
A7521001003Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or    Trach/laryn tube cuffed     37      A                                                                                                     C                          D1F P      02004010120040101        N
A7521002004equal, each
A7522001003Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and      Trach/laryn tube stainless  37      A                                                                                                     C                          D1F P      02004010120040101        N
A7522002004reusable), each
A7523001003Tracheostomy shower protector, each                                             Tracheostomy shower protect 37      A                                                                                                     C                          D1F P      02004010120040101        N
A7524001003Tracheostoma stent/stud/button, each                                            Tracheostoma stent/stud/bttn37      A                                                                                                     C                          D1F P      02004010120040101        N
A7525001003Tracheostomy mask, each                                                         Tracheostomy mask           37      A                                                                                                     C                          D1F P      02004010120040101        N
A7526001003Tracheostomy tube collar/holder, each                                           Tracheostomy tube collar    37      A                                                                                                     C                          D1F P      02004010120040101        N
A7527001003Tracheostomy/laryngectomy tube plug/stop, each                                  Trach/laryn tube plug/stop  37      A                                                                                                     C                          D1A P      02005010120050101        N
A8000001003Helmet, protective, soft, prefabricated, includes all components and accessoriesSoft protect helmet prefab  32      A                                                                                                     C                          D1E APR    02007010120070101        N
A8001001003Helmet, protective, hard, prefabricated, includes all components and accessoriesHard protect helmet prefab  32      A                                                                                                     C                          D1E APR    02007010120070101        N
A8002001003Helmet, protective, soft, custom fabricated, includes all components and        Soft protect helmet custom  45      A                                                                                                     C                          D1E APR    02007010120070101        N
A8002002004accessories
A8003001003Helmet, protective, hard, custom fabricated, includes all components and        Hard protect helmet custom  45      A                                                                                                     C                          D1E APR    02007010120070101        N
A8003002004accessories
A8004001003Soft interface for helmet, replacement only                                     Repl soft interface, helmet 32      A                                                                                                     C                          D1E APR    02007010120070101        N
A9150004003Non-prescription drugs                                                          Misc/exper non-prescript dru57      A                  2050.5                                                                             D                          O1E 9      01986010119950401        N
A9152001003Single vitamin/mineral/trace element, oral, per dose, not otherwise specified   Single vitamin nos          00      9                                                                                                     I                          Z2  9      02005010120050101        N
A9153001003Multiple vitamins, with or without minerals and trace elements, oral, per dose, Multi-vitamin nos           00      9                                                                                                     I                          Z2  9      02005010120050101        N
A9153002004not otherwise specified
A9155001003Artificial saliva, 30 ml                                                        Artificial saliva           57      A                                                                                                     C                          Z2  9      02008010120080101        N
A9180001003Pediculosis (lice infestation) treatment, topical, for administration by        Lice treatment, topical     00      9                                                                                                     I                          Z2  9      02005010120050101        N
A9180002004patient/caretaker
A9270001003Non-covered item or service                                                     Non-covered item or service 00      9                  2303                                                                               M                      0106Z2  9      01986010120020101        N
A9272001003Mechanical wound suction, disposable, includes dressing, all accessories and    Disposable mech wound suct  00      9                                                                                                     I                          D1A 9      02012010120120101        N
A9272002004components, each
A9273001003Hot water bottle, ice cap or collar, heat and/or cold wrap, any type            Hot/cold h2obot/cap/col/wrap00      9                                                                                                     M                      0137Z2  APR    02011010120110101        N
A9274001003External ambulatory insulin delivery system, disposable, each, includes all     Ext amb insulin delivery sys00      9                                                                                                     I                          D1A 9      02008010120080101        N
A9274002004supplies and accessories
A9275001003Home glucose disposable monitor, includes test strips                           Disp home glucose monitor   00      9                                                                                                     M                      0131T1E 9      02006010120060101        N
A9276001003Sensor; invasive (e. G. Subcutaneous), disposable, for use with interstitial    Disposable sensor, CGM sys  00      9                                          1861(n)                                                    S                          D1E 9      02008010120080101        N
A9276002004continuous glucose monitoring system, one unit = 1 day supply
A9277001003Transmitter; external, for use with interstitial continuous glucose monitoring  External transmitter, CGM   00      9                                          1861(n)                                                    S                          D1E 9      02008010120080101        N
A9277002004system
A9278001003Receiver (monitor); external, for use with interstitial continuous glucose      External receiver, CGM sys  00      9                                          1861(n)                                                    S                          D1E 9      02008010120080101        N
A9278002004monitoring system
A9279001003Monitoring feature/device, stand-alone or integrated, any type, includes all    Monitoring feature/deviceNOC00      9                                                                                                     I                          T2D 9      02007010120070101        N
A9279002004accessories, components and electronics, not otherwise classified
A9280001003Alert or alarm device, not otherwise classified                                 Alert device, noc           00      9                                          1861                                                       S                          Z2  9      02004010120040101        N
A9281001003Reaching/grabbing device, any type, any length, each                            Reaching/grabbing device    00      9                                          1862 SSA                                                   S                          D1E APR    02006010120060101        N
A9282001003Wig, any type, each                                                             Wig any type                00      9                                          1861SSA                                                    S                          Z2  9      02006010120060101        N
A9283001003Foot pressure off loading/supportive device, any type, each                     Foot press off load supp dev00      9                                          1862a(i)13                                                 S                          D1E P      02008010120080101        N
A9284001003Spirometer, non-electronic, includes all accessories                            Non-electronic spirometer   00      9                                                                                                     D                      0156Z2  APR    02009010120090101        N
A9300001003Exercise equipment                                                              Exercise equipment          00      960-9              2100.1                                                                             M                          Z2  9      01993010119950401        N
A9500002003Technetium tc-99m sestamibi, diagnostic, per study dose                         Tc99m sestamibi             57      A                                                                                                     C                          I1E 4      01996010120100101        N
A9501001003Technetium tc-99m teboroxime, diagnostic, per study dose                        Technetium TC-99m teboroxime57      A                                                                                                     C                          I1E 4      02008010120080101        N
A9502001003Technetium tc-99m tetrofosmin, diagnostic, per study dose                       Tc99m tetrofosmin           57      A                                                                                                     C                          I1E 4      01998010120090101        N
A9503001003Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries   Tc99m medronate             57      A                                                                                                     C                          I1E 4      01997010120060101        N
A9504001003Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries    Tc99m apcitide              57      A                                                                                                     C                          I1E 4      02000010120060101        N
A9505001003Thallium tl-201 thallous chloride, diagnostic, per millicurie                   TL201 thallium              57      A                                                                                                     C                          I1E 4      01996010120060101        N
A9507001003Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10          In111 capromab              57      A                                                                                                     C                          I1E 4      01999010120060101        N
A9507002004millicuries
A9508001003Iodine i-131 iobenguane sulfate, diagnostic, per 0. 5 millicurie                I131 iodobenguate, dx       51      A                                                                                                     C                          I1E 4      02001010120060101        N
A9509001003Iodine i-123 sodium iodide, diagnostic, per millicurie                          Iodine I-123 sod iodide mil 57      A                                                                                                     C                          I1E 4      02008010120080101        N
A9510001003Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries   Tc99m disofenin             51      A                                                                                                     C                          I1E 4      02001010120060101        N
A9512001003Technetium tc-99m pertechnetate, diagnostic, per millicurie                     Tc99m pertechnetate         57      A                                                                                                     C                          I1E 4      02003010120060101        N
A9516001003Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999          Iodine I-123 sod iodide mic 57      A                                                                                                     C                          I1E 4      02003010120080101        N
A9516002004microcuries
A9517001003Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie              I131 iodide cap, rx         57      A                                                                                                     C                          I1E 6      02003010120060101        N
A9521001003Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries Tc99m exametazime           57      A                                                                                                     C                          I1E 4      02003010120060101        N
A9524001003Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries             I131 serum albumin, dx      57      A                                                                                                     C                          I1E 4      02003010120060101        N
A9526001003Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries         Nitrogen N-13 ammonia       53      A                                                                                                     C                          I1E 4      02004010120060101        N
A9527001003Iodine i-125, sodium iodide solution, therapeutic, per millicurie               Iodine I-125 sodium iodide  57      A                                                                                                     CYY20080101                I1E 4      02007010120070101        N
A9528001003Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie               Iodine I-131 iodide cap, dx 57      A                                                                                                     C                          I1E 4      02004010120060101        N
A9529001003Iodine i-131 sodium iodide solution, diagnostic, per millicurie                 I131 iodide sol, dx         57      A                                                                                                     C                          I1E 4      02004010120060101        N
A9530001003Iodine i-131 sodium iodide solution, therapeutic, per millicurie                I131 iodide sol, rx         57      A                                                                                                     C                          I1E 6      02004010120060101        N
A9531001003Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)  I131 max 100uCi             57      A                                                                                                     C                          I1E 4      02004010120060101        N
A9532001003Iodine i-125 serum albumin, diagnostic, per 5 microcuries                       I125 serum albumin, dx      57      A                                                                                                     C                          I1E 6      02004010120060101        N
A9535001003Injection, methylene blue, 1 ml                                                 Injection, methylene blue   51      A                                                                                                     C                          I1E 4      0200601012010010120091231N
A9536001003Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries  Tc99m depreotide            57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9537001003Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries  Tc99m mebrofenin            57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9538001003Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25           Tc99m pyrophosphate         57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9538002004millicuries
A9539001003Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries   Tc99m pentetate             57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9540001003Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 Tc99m MAA                   57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9540002004millicuries
A9541001003Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20          Tc99m sulfur colloid        57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9541002004millicuries
A9542001003Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5         In111 ibritumomab, dx       51      A                                                                                                     C                          I1E 4      02006010120060101        N
A9542002004millicuries
A9543001003Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40    Y90 ibritumomab, rx         51      A                                                                                                     C                          I1E 6      02006010120060101        N
A9543002004millicuries
A9544001003Iodine i-131 tositumomab, diagnostic, per study dose                            I131 tositumomab, dx        57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9545001003Iodine i-131 tositumomab, therapeutic, per treatment dose                       I131 tositumomab, rx        57      A                                                                                                     C                          I1E 6      02006010120060101        N
A9546001003Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie Co57/58                     53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9547001003Indium in-111 oxyquinoline, diagnostic, per 0. 5 millicurie                     In111 oxyquinoline          53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9548001003Indium in-111 pentetate, diagnostic, per 0. 5 millicurie                        In111 pentetate             53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9550001003Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25       Tc99m gluceptate            53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9550002004millicurie
A9551001003Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries    Tc99m succimer              53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9552001003Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries   F18 fdg                     53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9553001003Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250           Cr51 chromate               53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9553002004microcuries
A9554001003Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10           I125 iothalamate, dx        53      A                                                                                                     C                          I1E 4      02006010120060101        N
A9554002004microcuries
A9555001003Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries                Rb82 rubidium               99      9                                                                                                     C                          I1E 4      02006010120060101        N
A9556001003Gallium ga-67 citrate, diagnostic, per millicurie                               Ga67 gallium                57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9557001003Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries    Tc99m bicisate              57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9558001003Xenon xe-133 gas, diagnostic, per 10 millicuries                                Xe133 xenon 10mci           57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9559001003Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1          Co57 cyano                  57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9559002004microcurie
A9560001003Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 Tc99m labeled rbc           57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9560002004millicuries
A9561001003Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries  Tc99m oxidronate            57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9562001003Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries  Tc99m mertiatide            57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9563001003Sodium phosphate p-32, therapeutic, per millicurie                              P32 Na phosphate            57      A                                                                                                     C                          I1E 6      02006010120060101        N
A9564001003Chromic phosphate p-32 suspension, therapeutic, per millicurie                  P32 chromic phosphate       57      A                                                                                                     C                          I1E 6      02006010120060101        N
A9566001003Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries Tc99m fanolesomab           57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9567001003Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75      Technetium TC-99m aerosol   57      A                                                                                                     C                          I1E 4      02006010120060101        N
A9567002004millicuries
A9568001003Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries Technetium tc99m arcitumomab53      A                                                                                                     C                          I1E 4      02007010120070101        N
A9569001003Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, Technetium TC-99m auto WBC  57      A                                                                                                     C                          I1E 4      02008010120080101        N
A9569002004per study dose
A9570001003Indium in-111 labeled autologous white blood cells, diagnostic, per study dose  Indium In-111 auto WBC      57      A                                                                                                     C                          I1E 4      02008010120080101        N
A9571001003Indium in-111 labeled autologous platelets, diagnostic, per study dose          Indium IN-111 auto platelet 57      A                                                                                                     C                          I1E 4      02008010120080101        N
A9572001003Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries    Indium In-111 pentetreotide 57      A                                                                                                     C                          I1E 4      02008010120080101        N
A9576001003Injection, gadoteridol, (prohance multipack), per ml                            Inj prohance multipack      51      A                                                                                                     C                          I1E 4      02008010120080101        N
A9577001003Injection, gadobenate dimeglumine (multihance), per ml                          Inj multihance              51      A                                                                                                     C                          I1E 4      02008010120080101        N
A9578001003Injection, gadobenate dimeglumine (multihance multipack), per ml                Inj multihance multipack    51      A                                                                                                     C                          I1E 4      02008010120080101        N
A9579001003Injection, gadolinium-based magnetic resonance contrast agent, not otherwise    Gad-base MR contrast NOS,1ml51      A                                                                                                     C                          I1E 4      02008010120080101        N
A9579002004specified (nos), per ml
A9580001003Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries          Sodium fluoride F-18        57      A                                                                                                     C                          I1E 4      02009010120090101        N
A9581001003Injection, gadoxetate disodium, 1 ml                                            Gadoxetate disodium inj     51      A                                                                                                     C                          I2D 1P     02010010120100101        N
A9582001003Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries       Iodine I-123 iobenguane     51      A                                                                                                     C                          I1E 4      02010010120100101        N
A9583001003Injection, gadofosveset trisodium, 1 ml                                         Gadofosveset trisodium inj  51      A                                                                                                     C                          I1E 4      02010010120100101        N
A9584001003Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries         Iodine I-123 ioflupane      57      A                                                                                                     CYY20120101                I1E 4      02012010120120101        N
A9585001003Injection, gadobutrol, 0. 1 ml                                                  Gadobutrol injection        57      A                                                                                                     C                          I1E 4      02012010120120101        N
A9586001003Florbetapir f18, diagnostic, per study dose, up to 10 millicuries               Florbetapir F18             00      9                                                                                                     M                      0183I1E 4      02013010120130101        A
A9600001003Strontium sr-89 chloride, therapeutic, per millicurie                           Sr89 strontium              57      A                                                                                                     C                          I1E 6      01998010120060101        N
A9604001003Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150          Sm 153 lexidronam           57      A                                                                                                     C                          I1E 6      02010010120100101        N
A9604002004millicuries
A9605001003Samarium sm-153 lexidronamm, therapeutic, per 50 millicuries                    Sm 153 lexidronm            57      A                                                                                                     C                          I1E 6      0199901012010010120091231N
A9698001003Non-radioactive contrast imaging material, not otherwise classified, per study  Non-rad contrast materialNOC51      A                  15022                                                                              D                          I1E 4      02006010120060101        N
A9699001003Radiopharmaceutical, therapeutic, not otherwise classified                      Radiopharm rx agent noc     57      A                                                                                                     C                          I1E 6      02003010120060101        N
A9700001003Supply of injectable contrast material for use in echocardiography, per study   Echocardiography Contrast   57      A                  15360                                                                              D                          I1E 9      02001010120010101        N
A9900002003Miscellaneous dme supply, accessory, and/or service component of another hcpcs  Supply/accessory/service    46      A                                                                                                     C                          D1E 9      02000010120010101        N
A9900003004code
A9901001003Dme delivery, set up, and/or dispensing service component of another hcpcs code Delivery/set up/dispensing  46      A                                                                                                     C                          D1E 9      02000010120010101        N
A9999001003Miscellaneous dme supply or accessory, not otherwise specified                  DME supply or accessory, nos46      A                                                                                                     C                          D1F 9      02004010120040101        N
B4034003003Enteral feeding supply kit; syringe fed, per day, includes but not limited to   Enter feed supkit syr by day39      A65-10             2130    4450                                                                       D                          O1C E      01986010120110101        N
B4034004004feeding/flushing syringe, administration set tubing, dressings, tape
B4035001003Enteral feeding supply kit;  pump fed, per day, includes but not limited to     Enteral feed supp pump per d39      A65-10             2130    4450                                                                       D                          O1C E      01986010120110101        N
B4035002004feeding/flushing syringe, administration set tubing, dressings, tape
B4036001003Enteral feeding supply kit; gravity fed, per day, includes but not limited to   Enteral feed sup kit grav by39      A65-10             2130    4450                                                                       D                          O1C E      01986010120110101        N
B4036002004feeding/flushing syringe, administration set tubing, dressings, tape
B4081001003Nasogastric tubing with stylet                                                  Enteral ng tubing w/ stylet 39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B4082001003Nasogastric tubing without stylet                                               Enteral ng tubing w/o stylet39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B4083001003Stomach tube - levine type                                                      Enteral stomach tube levine 39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B4087001003Gastrostomy/jejunostomy tube, standard, any material, any type, each            Gastro/jejuno tube, std     39      A                                                                                                     C                          O1C E      02008010120080101        N
B4088001003Gastrostomy/jejunostomy tube, low-profile, any material, any type, each         Gastro/jejuno tube, low-pro 39      A                                                                                                     C                          O1E E      02008010120080101        N
B4100001003Food thickener, administered orally, per ounce                                  Food thickener oral         00      960-9                                                                                                 M                          Z2  E      02003010120050101        N
B4102001003Enteral formula, for adults, used to replace fluids and electrolytes (e. G.     EF adult fluids and electro 39      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4102002004Clear liquids), 500 ml = 1 unit
B4103001003Enteral formula, for pediatrics, used to replace fluids and electrolytes (e. G. EF ped fluid and electrolyte46      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4103002004Clear liquids), 500 ml = 1 unit
B4104001003Additive for enteral formula (e. G. Fiber)                                      Additive for enteral formula00      965-10                                                                                                D                          O1C E      02005010120050101        N
B4149001003Enteral formula, manufactured blenderized natural foods with intact nutrients,  EF blenderized foods        39      A65-10             2130    4450                                                                       D                          O1C E      02005010120060101        N
B4149002004includes proteins, fats, carbohydrates, vitamins and minerals, may include
B4149003004fiber, administered through an enteral feeding tube, 100 calories = 1 unit
B4150001003Enteral formula, nutritionally complete with intact nutrients, includes         EF complet w/intact nutrient39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N
B4150002004proteins, fats, carbohydrates, vitamins and minerals, may include fiber,
B4150003004administered through an enteral feeding tube, 100 calories = 1 unit
B4152001003Enteral formula, nutritionally complete, calorically dense (equal to or greater EF calorie dense>/=1.5Kcal  39      A65-10             2130    4450                                                                       D                          O1C E      01984010120050101        N
B4152002004than 1. 5 kcal/ml) with intact nutrients, includes proteins, fats,
B4152003004carbohydrates, vitamins and minerals, may include fiber, administered through
B4152004004an enteral feeding tube, 100 calories = 1 unit
B4153001003Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and   EF hydrolyzed/amino acids   39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N
B4153002004peptide chain), includes fats, carbohydrates, vitamins and minerals, may
B4153003004include fiber, administered through an enteral feeding tube, 100 calories = 1
B4153004004unit
B4154001003Enteral formula, nutritionally complete, for special metabolic needs, excludes  EF spec metabolic noninherit39      A65-10             2130    4450                                                                       D                          O1C E      01984010120050101        N
B4154002004inherited disease of metabolism, includes altered composition of proteins,
B4154003004fats, carbohydrates, vitamins and/or minerals, may include fiber, administered
B4154004004through an enteral feeding tube, 100 calories = 1 unit
B4155001003Enteral formula, nutritionally incomplete/modular nutrients, includes specific  EF incomplete/modular       39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N
B4155002004nutrients, carbohydrates (e. G. Glucose polymers), proteins/amino acids (e. G.
B4155003004Glutamine, arginine), fat (e. G. Medium chain triglycerides) or combination,
B4155004004administered through an enteral feeding tube, 100 calories = 1 unit
B4157001003Enteral formula, nutritionally complete, for special metabolic needs for        EF special metabolic inherit39      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4157002004inherited disease of metabolism, includes proteins, fats, carbohydrates,
B4157003004vitamins and minerals, may include fiber, administered through an enteral
B4157004004feeding tube, 100 calories = 1 unit
B4158001003Enteral formula, for pediatrics, nutritionally complete with intact nutrients,  EF ped complete intact nut  46      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4158002004includes proteins, fats, carbohydrates, vitamins and minerals, may include
B4158003004fiber and/or iron, administered through an enteral feeding tube, 100 calories =
B41580040041 unit
B4159001003Enteral formula, for pediatrics, nutritionally complete soy based with intact   EF ped complete soy based   46      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4159002004nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may
B4159003004include fiber and/or iron, administered through an enteral feeding tube, 100
B4159004004calories = 1 unit
B4160001003Enteral formula, for pediatrics, nutritionally complete calorically dense       EF ped caloric dense>/=0.7kc46      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4160002004(equal to or greater than 0. 7 kcal/ml) with intact nutrients, includes
B4160003004proteins, fats, carbohydrates, vitamins and minerals, may include fiber,
B4160004004administered through an enteral feeding tube, 100 calories = 1 unit
B4161001003Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain       EF ped hydrolyzed/amino acid46      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4161002004proteins, includes fats, carbohydrates, vitamins and minerals, may include
B4161003004fiber, administered through an enteral feeding tube, 100 calories = 1 unit
B4162001003Enteral formula, for pediatrics, special metabolic needs for inherited disease  EF ped specmetabolic inherit46      A65-10                                                                                                D                          O1C E      02005010120050101        N
B4162002004of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals,
B4162003004may include fiber, administered through an enteral feeding tube, 100 calories =
B41620040041 unit
B4164001003Parenteral nutrition solution:  carbohydrates (dextrose), 50% or less (500 ml = Parenteral 50% dextrose solu39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B41640020041 unit) - homemix
B4168001003Parenteral nutrition solution; amino acid, 3. 5%, (500 ml = 1 unit) - homemix   Parenteral sol amino acid 3.39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N
B4172001003Parenteral nutrition solution; amino acid, 5. 5% through 7%, (500 ml = 1 unit)  Parenteral sol amino acid 5.39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N
B4172002004- homemix
B4176001003Parenteral nutrition solution; amino acid, 7% through 8. 5%, (500 ml = 1 unit)  Parenteral sol amino acid 7-39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B4176002004- homemix
B4178001003Parenteral nutrition solution: amino acid, greater than 8. 5% (500 ml = 1 unit) Parenteral sol amino acid > 39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B4178002004- homemix
B4180001003Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500  Parenteral sol carb > 50%   39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B4180002004ml=1 unit) - homemix
B4185001003Parenteral nutrition solution, per 10 grams lipids                              Parenteral sol 10 gm lipids 39      A                                                                                                     D                      0126O1C E      02006010120060101        N
B4189001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol amino acid & 39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B4189002004electrolytes, trace elements, and vitamins, including preparation, any
B4189003004strength, 10 to 51 grams of protein - premix
B4193001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol 52-73 gm prot39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B4193002004electrolytes, trace elements, and vitamins, including preparation, any
B4193003004strength, 52 to 73 grams of protein - premix
B4197001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol 74-100 gm pro39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B4197002004electrolytes, trace elements and vitamins, including preparation, any strength,
B419700300474 to 100 grams of protein - premix
B4199001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol > 100gm prote39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B4199002004electrolytes, trace elements and vitamins, including preparation, any strength,
B4199003004over 100 grams of protein - premix
B4216001003Parenteral nutrition; additives (vitamins, trace elements, heparin,             Parenteral nutrition additiv39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N
B4216002004electrolytes) homemix per day
B4220001003Parenteral nutrition supply kit; premix, per day                                Parenteral supply kit premix39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N
B4222001003Parenteral nutrition supply kit; home mix, per day                              Parenteral supply kit homemi39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B4224001003Parenteral nutrition administration kit, per day                                Parenteral administration ki39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N
B5000001003Parenteral nutrition solution:  compounded amino acid and carbohydrates with    Parenteral sol renal-amirosy39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B5000002004electrolytes, trace elements, and vitamins, including preparation, any
B5000003004strength, renal - amirosyn rf, nephramine, renamine - premix
B5100001003Parenteral nutrition solution: compounded amino acid and carbohydrates with     Parenteral sol hepatic-fream39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B5100002004electrolytes, trace elements, and vitamins, including preparation, any
B5100003004strength, hepatic - freamine hbc, hepatamine - premix
B5200001003Parenteral nutrition solution:  compounded amino acid and carbohydrates with    Parenteral sol stres-brnch c39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N
B5200002004electrolytes, trace elements, and vitamins, including preparation, any
B5200003004strength, stress - branch chain amino acids - premix
B9000002003Enteral nutrition infusion pump - without alarm                                 Enter infusion pump w/o alrm39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N
B9002001003Enteral nutrition infusion pump - with alarm                                    Enteral infusion pump w/ ala39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N
B9004001003Parenteral nutrition infusion pump, portable                                    Parenteral infus pump portab39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N
B9006001003Parenteral nutrition infusion pump, stationary                                  Parenteral infus pump statio39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N
B9998001003Noc for enteral supplies                                                        Enteral supp not otherwise c57      A65-10             2130    4450                                                                       D                          O1C E      01985010119960101        N
B9999001003Noc for parenteral supplies                                                     Parenteral supp not othrws c57      A65-10             2130    4450                                                                       D                          O1C E      01985010119960101        N
C1300001003Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval     HYPERBARIC Oxygen           53      A                                          1833(T)                                                    D                      0093P5E 9      02000080120030701        N
C1713001003Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)     Anchor/screw bn/bn,tis/bn   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1714001003Catheter, transluminal atherectomy, directional                                 Cath, trans atherectomy, dir53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1715001003Brachytherapy needle                                                            Brachytherapy needle        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1716001003Brachytherapy source, non-stranded, gold-198, per source                        Brachytx, non-str, Gold-198 53      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N
C1717001003Brachytherapy source, non-stranded, high dose rate iridium-192, per source      Brachytx, non-str,HDR Ir-19253      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N
C1719001003Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source  Brachytx, NS, Non-HDRIr-192 53      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N
C1721001003Cardioverter-defibrillator, dual chamber (implantable)                          AICD, dual chamber          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1722001003Cardioverter-defibrillator, single chamber (implantable)                        AICD, single chamber        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1724001003Catheter, transluminal atherectomy, rotational                                  Cath, trans atherec,rotation53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1725001003Catheter, transluminal angioplasty, non-laser (may include guidance,            Cath, translumin non-laser  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1725002004infusion/perfusion capability)
C1726001003Catheter, balloon dilatation, non-vascular                                      Cath, bal dil, non-vascular 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1727001003Catheter, balloon tissue dissector, non-vascular (insertable)                   Cath, bal tis dis, non-vas  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1728001003Catheter, brachytherapy seed administration                                     Cath, brachytx seed adm     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1729001003Catheter, drainage                                                              Cath, drainage              53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1730001003Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer     Cath, EP, 19 or few elect   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1730002004electrodes)
C1731001003Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more      Cath, EP, 20 or more elec   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1731002004electrodes)
C1732001003Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping          Cath, EP, diag/abl, 3D/vect 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1733001003Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector       Cath, EP, othr than cool-tip53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1733002004mapping, other than cool-tip
C1749001003Endoscope, retrograde imaging/illumination colonoscope device (implantable)     Endo, colon, retro imaging  53      A                                          1833(t)                                                    D                          D1A 9S     02010100120101001        N
C1750001003Catheter, hemodialysis/peritoneal, long-term                                    Cath, hemodialysis,long-term53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N
C1751001003Catheter, infusion, inserted peripherally, centrally or midline (other than     Cath, inf, per/cent/midline 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1751002004hemodialysis)
C1752001003Catheter, hemodialysis/peritoneal, short-term                                   Cath,hemodialysis,short-term53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N
C1753001003Catheter, intravascular ultrasound                                              Cath, intravas ultrasound   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1754001003Catheter, intradiscal                                                           Catheter, intradiscal       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1755001003Catheter, intraspinal                                                           Catheter, intraspinal       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1756001003Catheter, pacing, transesophageal                                               Cath, pacing, transesoph    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1757001003Catheter, thrombectomy/embolectomy                                              Cath, thrombectomy/embolect 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1758001003Catheter, ureteral                                                              Catheter, ureteral          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1759001003Catheter, intracardiac echocardiography                                         Cath, intra echocardiography53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1760001003Closure device, vascular (implantable/insertable)                               Closure dev, vasc           53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1762001003Connective tissue, human (includes fascia lata)                                 Conn tiss, human(inc fascia)53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1763001003Connective tissue, non-human (includes synthetic)                               Conn tiss, non-human        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1764001003Event recorder, cardiac (implantable)                                           Event recorder, cardiac     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1765001003Adhesion barrier                                                                Adhesion barrier            53      A                                          1833(T)                                                    D                          D1A 9S     02001070120010701        N
C1766001003Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other Intro/sheath,strble,non-peel53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1766002004than peel-away
C1767001003Generator, neurostimulator (implantable), non-rechargeable                      Generator, neuro non-recharg53      A                                          1833(T)                                                    D                          D1A 9S     02001040120060101        N
C1768001003Graft, vascular                                                                 Graft, vascular             53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1769001003Guide wire                                                                      Guide wire                  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1770001003Imaging coil, magnetic resonance (insertable)                                   Imaging coil, MR, insertable53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1771001003Repair device, urinary, incontinence, with sling graft                          Rep dev, urinary, w/sling   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1772001003Infusion pump, programmable (implantable)                                       Infusion pump, programmable 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1773001003Retrieval device, insertable (used to retrieve fractured medical devices)       Ret dev, insertable         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1776001003Joint device (implantable)                                                      Joint device (implantable)  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1777001003Lead, cardioverter-defibrillator, endocardial single coil (implantable)         Lead, AICD, endo single coil53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1778001003Lead, neurostimulator (implantable)                                             Lead, neurostimulator       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1779001003Lead, pacemaker, transvenous vdd single pass                                    Lead, pmkr, transvenous VDD 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1780001003Lens, intraocular (new technology)                                              Lens, intraocular (new tech)53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1781001003Mesh (implantable)                                                              Mesh (implantable)          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1782001003Morcellator                                                                     Morcellator                 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1783001003Ocular implant, aqueous drainage assist device                                  Ocular imp, aqueous drain de53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N
C1784001003Ocular device, intraoperative, detached retina                                  Ocular dev, intraop, det ret53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1785001003Pacemaker, dual chamber, rate-responsive (implantable)                          Pmkr, dual, rate-resp       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1786001003Pacemaker, single chamber, rate-responsive (implantable)                        Pmkr, single, rate-resp     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1787001003Patient programmer, neurostimulator                                             Patient progr, neurostim    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1788001003Port, indwelling (implantable)                                                  Port, indwelling, imp       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1789001003Prosthesis, breast (implantable)                                                Prosthesis, breast, imp     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1813001003Prosthesis, penile, inflatable                                                  Prosthesis, penile, inflatab53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1814001003Retinal tamponade device, silicone oil                                          Retinal tamp, silicone oil  53      A                                          1833t                                                      D                          D1A 9S     02003040120030401        N
C1815001003Prosthesis, urinary sphincter (implantable)                                     Pros, urinary sph, imp      53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1816001003Receiver and/or transmitter, neurostimulator (implantable)                      Receiver/transmitter, neuro 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1817001003Septal defect implant system, intracardiac                                      Septal defect imp sys       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1818001003Integrated keratoprosthesis                                                     Integrated keratoprosthesis 53      A                                          1833T                                                      D                          D1A 9S     02003070120030701        N
C1819001003Surgical tissue localization and excision device (implantable)                  Tissue localization-excision53      A                                          1833T                                                      D                      0093D1A 9S     02004010120040101        N
C1820001003Generator, neurostimulator (implantable), with rechargeable battery and         Generator neuro rechg bat sy53      A                                          1833(T)                                                    D                          D1A 9      02006010120060101        N
C1820002004charging system
C1821001003Interspinous process distraction device (implantable)                           Interspinous implant        53      A                                          1833(T)                                                    D                          D1A 9      02007010120070101        N
C1830001003Powered bone marrow biopsy needle                                               Power bone marrow bx needle 53      A                                          1833(t)                                                    DYY20111001                D1A 9S     02011100120111001        N
C1840001003Lens, intraocular (telescopic)                                                  Telescopic intraocular lens 53      A                                          1833(t)                                                    DYY20111001                D1A 9S     02011100120111001        N
C1874001003Stent, coated/covered, with delivery system                                     Stent, coated/cov w/del sys 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1875001003Stent, coated/covered, without delivery system                                  Stent, coated/cov w/o del sy53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1876001003Stent, non-coated/non-covered, with delivery system                             Stent, non-coa/non-cov w/del53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1877001003Stent, non-coated/non-covered, without delivery system                          Stent, non-coat/cov w/o del 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1878001003Material for vocal cord medialization, synthetic (implantable)                  Matrl for vocal cord        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1879001003Tissue marker (implantable)                                                     Tissue marker, implantable  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1880001003Vena cava filter                                                                Vena cava filter            53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1881001003Dialysis access system (implantable)                                            Dialysis access system      53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1882001003Cardioverter-defibrillator, other than single or dual chamber (implantable)     AICD, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1883001003Adaptor/extension, pacing lead or neurostimulator lead (implantable)            Adapt/ext, pacing/neuro lead53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1884001003Embolization protective system                                                  Embolization Protect syst   53      A                                          1833T                                                      D                          D1A 9S     02003010120030101        N
C1885001003Catheter, transluminal angioplasty, laser                                       Cath, translumin angio laser53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1886001003Catheter, extravascular tissue ablation, any modality (insertable)              Catheter, ablation          53      A                                          1833(t)                                                    DYY20120101                D1A 9S     02012010120120101        N
C1887001003Catheter, guiding (may include infusion/perfusion capability)                   Catheter, guiding           53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1888001003Catheter, ablation, non-cardiac, endovascular (implantable)                     Endovas non-cardiac abl cath53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N
C1891001003Infusion pump, non-programmable, permanent (implantable)                        Infusion pump,non-prog, perm53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1892001003Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve,     Intro/sheath,fixed,peel-away53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1892002004peel-away
C1893001003Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve,     Intro/sheath, fixed,non-peel53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1893002004other than peel-away
C1894001003Introducer/sheath, other than guiding, other than intracardiac                  Intro/sheath, non-laser     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120020701        N
C1894002004electrophysiological, non-laser
C1895001003Lead, cardioverter-defibrillator, endocardial dual coil (implantable)           Lead, AICD, endo dual coil  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1896001003Lead, cardioverter-defibrillator, other than endocardial single or dual coil    Lead, AICD, non sing/dual   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1896002004(implantable)
C1897001003Lead, neurostimulator test kit (implantable)                                    Lead, neurostim test kit    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1898001003Lead, pacemaker, other than transvenous vdd single pass                         Lead, pmkr, other than trans53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1899001003Lead, pacemaker/cardioverter-defibrillator combination (implantable)            Lead, pmkr/AICD combination 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C1900001003Lead, left ventricular coronary venous system                                   Lead, coronary venous       53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N
C2614001003Probe, percutaneous lumbar discectomy                                           Probe, perc lumb disc       53      A                                          1833(T)                                                    D                      0093D1A 9S     02003010120030101        N
C2615001003Sealant, pulmonary, liquid                                                      Sealant, pulmonary, liquid  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2616001003Brachytherapy source, non-stranded, yttrium-90, per source                      Brachytx, non-str,Yttrium-9053      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N
C2617001003Stent, non-coronary, temporary, without delivery system                         Stent, non-cor, tem w/o del 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2618001003Probe, cryoablation                                                             Probe, cryoablation         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N
C2619001003Pacemaker, dual chamber, non rate-responsive (implantable)                      Pmkr, dual, non rate-resp   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2620001003Pacemaker, single chamber, non rate-responsive (implantable)                    Pmkr, single, non rate-resp 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N
C2621001003Pacemaker, other than single or dual chamber (implantable)                      Pmkr, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2622001003Prosthesis, penile, non-inflatable                                              Prosthesis, penile, non-inf 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2625001003Stent, non-coronary, temporary, with delivery system                            Stent, non-cor, tem w/del sy53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2626001003Infusion pump, non-programmable, temporary (implantable)                        Infusion pump, non-prog,temp53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2627001003Catheter, suprapubic/cystoscopic                                                Cath, suprapubic/cystoscopic53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2628001003Catheter, occlusion                                                             Catheter, occlusion         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2629001003Introducer/sheath, other than guiding, intracardiac electrophysiological, laser Intro/sheath, laser         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2630001003Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector       Cath, EP, cool-tip          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2630002004mapping, cool-tip
C2631001003Repair device, urinary, incontinence, without sling graft                       Rep dev, urinary, w/o sling 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N
C2634001003Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.  Brachytx, non-str, HA, I-12553      A                                          1833(T)                                                    DYY20080101                I4B 9      02005010120070701        N
C263400200401 mci (nist), per source
C2635001003Brachytherapy source, non-stranded, high activity, paladium-103, greater than   Brachytx, non-str, HA, P-10353      A                                          1833(T)                                                    DYY20080101                I4B 9      02005010120070701        N
C26350020042. 2 mci (nist), per source
C2636001003Brachytherapy linear source, non-stranded, paladium-103, per 1 mm               Brachy linear, non-str,P-10353      A                                          1833(T)                                                    DYY20080101                I4B 9      02005010120070701        N
C2637001003Brachytherapy source, non-stranded, ytterbium-169, per source                   Brachy,non-str,Ytterbium-16953      A                                          1833(T)                                                    D                          I4B 4      02005100120070701        N
C2638001003Brachytherapy source, stranded, iodine-125, per source                          Brachytx, stranded, I-125   53      A                                          1833(t)(2)                                                 DYY20080101                I4B 6      02007070120070701        N
C2639001003Brachytherapy source, non-stranded, iodine-125, per source                      Brachytx, non-stranded,I-12553      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N
C2640001003Brachytherapy source, stranded, palladium-103, per source                       Brachytx, stranded, P-103   53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N
C2641001003Brachytherapy source, non-stranded, palladium-103, per source                   Brachytx, non-stranded,P-10353      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N
C2642001003Brachytherapy source, stranded, cesium-131, per source                          Brachytx, stranded, C-131   53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N
C2643001003Brachytherapy source, non-stranded, cesium-131, per source                      Brachytx, non-stranded,C-13153      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N
C2698001003Brachytherapy source, stranded, not otherwise specified, per source             Brachytx, stranded, NOS     53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N
C2699001003Brachytherapy source, non-stranded, not otherwise specified, per source         Brachytx, non-stranded, NOS 53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N
C8900002003Magnetic resonance angiography with contrast, abdomen                           MRA w/cont, abd             53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8901001003Magnetic resonance angiography without contrast, abdomen                        MRA w/o cont, abd           53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8902001003Magnetic resonance angiography without contrast followed by with contrast,      MRA w/o fol w/cont, abd     53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8902002004abdomen
C8903001003Magnetic resonance imaging with contrast, breast; unilateral                    MRI w/cont, breast,  uni    53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8904001003Magnetic resonance imaging without contrast, breast; unilateral                 MRI w/o cont, breast, uni   53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8905001003Magnetic resonance imaging without contrast followed by with contrast, breast;  MRI w/o fol w/cont, brst, un53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8905002004unilateral
C8906001003Magnetic resonance imaging with contrast, breast; bilateral                     MRI w/cont, breast,  bi     53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8907001003Magnetic resonance imaging without contrast, breast; bilateral                  MRI w/o cont, breast, bi    53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8908001003Magnetic resonance imaging without contrast followed by with contrast, breast;  MRI w/o fol w/cont, breast, 53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8908002004bilateral
C8909001003Magnetic resonance angiography with contrast, chest (excluding myocardium)      MRA w/cont, chest           53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8910001003Magnetic resonance angiography without contrast, chest (excluding myocardium)   MRA w/o cont, chest         53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8911001003Magnetic resonance angiography without contrast followed by with contrast,      MRA w/o fol w/cont, chest   53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8911002004chest (excluding myocardium)
C8912001003Magnetic resonance angiography with contrast, lower extremity                   MRA w/cont, lwr ext         53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8913001003Magnetic resonance angiography without contrast, lower extremity                MRA w/o cont, lwr ext       53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8914001003Magnetic resonance angiography without contrast followed by with contrast,      MRA w/o fol w/cont, lwr ext 53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N
C8914002004lower extremity
C8918001003Magnetic resonance angiography with contrast, pelvis                            MRA w/cont, pelvis          53      A                                          430 BIPA                                                   DYY20080101                I2D 4      02003070120030701        N
C8919001003Magnetic resonance angiography without contrast, pelvis                         MRA w/o cont, pelvis        53      A                                          430 BIPA                                                   DYY20080101                I2D 4      02003070120030701        N
C8920001003Magnetic resonance angiography without contrast followed by with contrast,      MRA w/o fol w/cont, pelvis  53      A                                          430 BIPA                                                   DYY20080101                I2D 4      02003070120030701        N
C8920002004pelvis
C8921001003Transthoracic echocardiography with contrast, or without contrast followed by   TTE w or w/o fol w/cont, com53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N
C8921002004with contrast, for congenital cardiac anomalies; complete
C8922001003Transthoracic echocardiography with contrast, or without contrast followed by   TTE w or w/o fol w/cont, f/u53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N
C8922002004with contrast, for congenital cardiac anomalies; follow-up or limited study
C8923001003Transthoracic echocardiography with contrast, or without contrast followed by   2D TTE w or w/o fol w/con,co53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N
C8923002004with contrast, real-time with image documentation (2d), includes m-mode
C8923003004recording, when performed, complete, without spectral or color doppler
C8923004004echocardiography
C8924001003Transthoracic echocardiography with contrast, or without contrast followed by   2D TTE w or w/o fol w/con,fu53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N
C8924002004with contrast, real-time with image documentation (2d), includes m-mode
C8924003004recording, when performed, follow-up or limited study
C8925001003Transesophageal echocardiography (tee) with contrast, or without contrast       2D TEE w or w/o fol w/con,in53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N
C8925002004followed by with contrast, real time with image documentation (2d) (with or
C8925003004without m-mode recording); including probe placement, image acquisition,
C8925004004interpretation and report
C8926001003Transesophageal echocardiography (tee) with contrast, or without contrast       TEE w or w/o fol w/cont,cong53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N
C8926002004followed by with contrast, for congenital cardiac anomalies; including probe
C8926003004placement, image acquisition, interpretation and report
C8927001003Transesophageal echocardiography (tee) with contrast, or without contrast       TEE w or w/o fol w/cont, mon53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N
C8927002004followed by with contrast, for monitoring purposes, including probe placement,
C8927003004real time 2-dimensional image acquisition and interpretation leading to ongoing
C8927004004(continuous) assessment of (dynamically changing) cardiac pumping function and
C8927005004to therapeutic measures on an immediate time basis
C8928001003Transthoracic echocardiography with contrast, or without contrast followed by   TTE w or w/o fol w/con,stres53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N
C8928002004with contrast, real-time with image documentation (2d), includes m-mode
C8928003004recording, when performed, during rest and cardiovascular stress test using
C8928004004treadmill, bicycle exercise and/or pharmacologically induced stress, with
C8928005004interpretation and report
C8929001003Transthoracic echocardiography with contrast, or without contrast followed by   TTE w or wo fol wcon,Doppler53      A                                          1833(t)(2)                                                 D                          I3C 4      02009010120090101        N
C8929002004with contrast, real-time with image documentation (2d), includes m-mode
C8929003004recording, when performed, complete, with spectral doppler echocardiography,
C8929004004and with color flow doppler echocardiography
C8930001003Transthoracic echocardiography, with contrast, or without contrast followed by  TTE w or w/o contr, cont ECG53      A                                          1833(t)(2)                                                 D                          I3C 4      02009010120090101        N
C8930002004with contrast, real-time with image documentation (2d), includes m-mode
C8930003004recording, when performed, during rest and cardiovascular stress test using
C8930004004treadmill, bicycle exercise and/or pharmacologically induced stress, with
C8930005004interpretation and report; including performance of continuous
C8930006004electrocardiographic monitoring, with physician supervision
C8931001003Magnetic resonance angiography with contrast, spinal canal and contents         MRA, w/dye, spinal canal    53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N
C8932001003Magnetic resonance angiography without contrast, spinal canal and contents      MRA, w/o dye, spinal canal  53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N
C8933001003Magnetic resonance angiography without contrast followed by with contrast,      MRA, w/o&w/dye, spinal canal53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N
C8933002004spinal canal and contents
C8934001003Magnetic resonance angiography with contrast, upper extremity                   MRA, w/dye, upper extremity 53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N
C8935001003Magnetic resonance angiography without contrast, upper extremity                MRA, w/o dye, upper extr    53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N
C8936001003Magnetic resonance angiography without contrast followed by with contrast,      MRA, w/o&w/dye, upper extr  53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N
C8936002004upper extremity
C8957001003Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion    Prolonged IV inf, req pump  99      9                                          1833(t)                                                    D                          P6D 1      02006010120060101        N
C8957002004(more than 8 hours), requiring use of portable or implantable pump
C9113001003Injection, pantoprazole sodium, per vial                                        Inj pantoprazole sodium, via53      A                                          1833(T)                                                    D                          O1E 9      02002010120020101        N
C9121001003Injection, argatroban, per 5 mg                                                 Injection, argatroban       53      A                                          1833(T)                                                    DYY20080101            0093O1E 1P     02003010120030101        N
C9245001003Injection, romiplostim, 10 mcg                                                  Injection, romiplostim      53      A                                          1833(t)                           J2796                    D                          O1E 1      0200901012010010120091231N
C9246001003Injection, gadoxetate disodium, per ml                                          Inj, gadoxetate disodium    53      A                                          1833(t)                           A9581                    D                          O1E 1      0200901012010010120091231N
C9247001003Iobenguane, i-123, diagnostic, per study dose, up to 10 millicuries             Inj, iobenguane, I-123, dx  53      A                                          1833(t)                           A9582                    D                          O1E 1      0200901012010010120091231N
C9248001003Injection, clevidipine butyrate, 1 mg                                           Inj, clevidipine butyrate   53      A                                          1833(t)                                                    DYY20090101                O1E 1      02009010120090101        N
C9249001003Injection, certolizumab pegol, 1 mg                                             Inj, certolizumab pegol     53      A                                          621MMA                            J0718                    D                          O1E 1      0200904012010010120091231N
C9250001003Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2ml      Artiss fibrin sealant       53      A                                          621MMA                                                     DYY20090701                O1E 9      02009070120090701        N
C9251001003Injection, c1 esterase inhibitor (human), 10 units                              Inj, C1 esterase inhibitor  53      A                                          621MMA                            J0598                    D                          O1E 9      0200907012010010120091231N
C9252001003Injection, plerixafor, 1 mg                                                     Injection, plerixafor       53      A                                          621MMA                            J2562                    D                          O1E 9      0200907012010010120091231N
C9253001003Injection, temozolomide, 1 mg                                                   Injection, temozolomide     53      A                                          621MMA                            J9328                    D                          O1D 9      0200907012010010120091231N
C9254001003Injection, lacosamide, 1 mg                                                     Injection, lacosamide       53      A                                          621MMA                                                     D                          O1E 9      02010010120100101        N
C9255001003Injection, paliperidone palmitate, 1 mg                                         Paliperidone palmitate inj  53      A                                          621MMA                            J2426                    D                          O1E 9      0201001012011010120101231N
C9256001003Injection, dexamethasone intravitreal implant, 0. 1 mg                          Dexamethasone intravitreal  53      A                                          621MMA                            J7312                    D                          O1E 9      0201001012011010120101231N
C9257001003Injection, bevacizumab, 0. 25 mg                                                Bevacizumab injection       53      A                                          1833(t)                                                    DYY20100101                O1E 9      02010010120100101        N
C9258001003Injection, telavancin, 10 mg                                                    Telavancin injection        53      A                                          1833(t)                           J3095                    D                          O1E 9      0201004012011010120101231N
C9259001003Injection, pralatrexate, 1 mg                                                   Pralatrexate injection      53      A                                          1833(t)                           J9307                    D                          O1D 9      0201004012011010120101231N
C9260001003Injection, ofatumumab, 10 mg                                                    Ofatumumab injection        53      A                                          1883(t)                           J9302                    D                          O1D 9      0201004012011010120101231N
C9261001003Injection, ustekinumab, 1 mg                                                    Ustekinumab injection       53      A                                          1883(t)                           J3357                    D                          O1E 9      0201004012011010120101231N
C9262001003Fludarabine phosphate, oral, 1 mg                                               Fludarabine phosphate, oral 53      A                                          1833(t)                           Q2025                    D                          O1D 9      0201004012010070120100630N
C9263001003Injection, ecallantide, 1 mg                                                    Ecallantide injection       53      A                                          1833(t)                           J1290                    D                          O1E 9      0201004012011010120101231N
C9264001003Injection, tocilizumab, 1 mg                                                    Tocilizumab injection       53      A                                          1833(t)(6)                        J3262                    D                      0093O1E 9      0201007012011010120101231N
C9265001003Injection, romidepsin, 1 mg                                                     Romidepsin injection        53      A                                          1833(t)(6)                        J9315                    D                      0093O1D 9      0201007012011010120101231N
C9266001003Injection, collagenase clostridium histolyticum, 0. 1 mg                        Collagenase clostridum histo53      A                                          1833(t)(6)                        J0775                    D                      0093O1E 9      0201007012011010120101231N
C9267001003Injection, von willebrand factor complex (human), wilate, per 100 iu vwf: rco   Injection, Wilate           53      A                                          1833(t)(6)                        J7184                    D                      0093O1E 9      0201007012011010120101231N
C9268001003Capsaicin, patch, 10cm2                                                         Capsaicin patch             53      A                                          1833(t)(6)                        J7335                    D                      0093O1E 9      0201007012011010120101231N
C9269001003Injection, c-1 esterase inhibitor (human), berinert, 10 units                   C-1 esterase, berinert      53      A                                          1833(t)                           J0597                    D                          O1E 9      0201010012011010120101231N
C9270001003Injection, immune globulin (gammaplex), intravenous, non-lyophilized (e. G.     Gammaplex IVIG              53      A                                          1833(t)                           J1557                    D                          O1E 9      0201010012012010120111231N
C9270002004Liquid), 500 mg
C9271001003Injection, velaglucerase alfa, 100 units                                        Velaglucerase alfa          53      A                                          1833(t)                           J3385                    D                          O1E 9      0201010012011010120101231N
C9272001003Injection, denosumab, 1 mg                                                      Inj, denosumab              53      A                                          1833(t)                           J0897                    D                          O1E 9      0201010012012010120111231N
C9273001003Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with       Sipuleucel-T, per infusion  53      A                                          1833(t)                           Q2043                    D                          O1D 1      0201010012011070120110630N
C9273002004pap-gm-csf, including leukapheresis and all other preparatory procedures, per
C9273003004infusion
C9274001003Crotalidae polyvalent immune fab (ovine), 1 vial                                Crotalidae Poly Immune Fab  53      A                                          1833(t)                           J0840                    D                          O1E 9      0201101012012010120111231N
C9275001003Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose             Hexaminolevulinate HCl      53      A                                          1833(t)                                                    D                          O1E 4      02011010120110101        N
C9276001003Injection, cabazitaxel, 1 mg                                                    Cabazitaxel injection       53      A                                          1833(t)                           J9043                    D                          O1D 9      0201101012012010120111231N
C9277001003Injection, alglucosidase alfa (lumizyme), 1 mg                                  Lumizyme, 1 mg              53      A                                          1833(t)                           J0221                    D                          O1E 9      0201101012012010120111231N
C9278001003Injection, incobotulinumtoxin a, 1 unit                                         Incobotulinumtoxin A        53      A                                          1833(t)                           Q2040                    D                          O1E 9      0201101012011040120110331N
C9279001003Injection, ibuprofen, 100 mg                                                    Injection, ibuprofen        53      A                                          1833(t)                           J1741                    D                      0093O1E 1      0201101012013010120121231D
C9280001003Injection, eribulin mesylate, 1 mg                                              Injection, eribulin mesylate53      A                                          1833(t)(6)                        J9179                    D                      0093O1D 1      0201104012012010120111231N
C9281001003Injection, pegloticase, 1 mg                                                    Injection, pegloticase      53      A                                          1833(t)(6)                        J2507                    D                      0093O1E 1      0201104012012010120111231N
C9282001003Injection, ceftaroline fosamil, 10 mg                                           Inj, ceftaroline fosamil    53      A                                          1833(t)(6)                        J0712                    D                      0093O1E 1      0201104012012010120111231N
C9283001003Injection, acetaminophen, 10 mg                                                 Injection, acetaminophen    53      A                                          1833(t)                           J0131                    D                      0093O1E 1      0201107012012010120111231N
C9284001003Injection, ipilimumab, 1 mg                                                     Injection, ipilimumab       53      A                                          1833(t)                           J9228                    D                      0093O1D 1      0201107012012010120111231N
C9285001003Lidocaine 70 mg/tetracaine 70 mg, per patch                                     Patch, lidocaine/tetracaine 53      A                                          1833(t)                                                    DYY20110701            0093O1E 1      02011070120110701        N
C9286001003Injection, belatacept, 1 mg                                                     Injection, belatacept       53      A                                          1833(t)                           J0485                    D                          O1E 1      0201110012013010120121231D
C9287001003Injection, brentuximab vedotin, 1 mg                                            Inj, brentuximab vedotin    53      A                                          1833(t)                           J9042                    D                          O1D 1      0201201012013010120121231D
C9288001003Injection, centruroides (scorpion) immune f(ab)2 (equine), 1 vial               Inj, centruroides (scorpion)53      A                                          1833(t)                           J0716                    DYY20120401                O1E 9      0201204012013010120121231D
C9289001003Injection, asparaginase erwinia chrysanthemi, 1,000 international units (i. U. )Inj, erwinia chrysanthemi   53      A                                          1833(t)                           J9019                    DYY20120401                O1D 9      0201204012013010120121231D
C9290001003Injection, bupivacaine liposome, 1 mg                                           Inj, bupivacaine liposome   53      A                                          1833(t)                                                    DYY20120401                O1E 1      02012040120120401        A
C9291001003Injection, aflibercept, 2 mg vial                                               Injection, aflibercept      53      A                                          1833(t)                           J0178Q2046               D                          O1E 9      0201204012012070120120630D
C9292001003Injection, pertuzumab, 10 mg                                                    Injection, pertuzumab       53      A                                          1833(t)                                                    DYY20121001                O1D 1      02012100120121001        A
C9293001003Injection, glucarpidase, 10 units                                               Injection, glucarpidase     53      A                                          1833(t)                                                    DYY20121001                O1E 1      02012100120121001        A
C9294001003Injection, taliglucerase alfa, 10 units                                         Inj, taliglucerase alfa     53      A                                          1833(t)                                                    DYY20130101                O1E 1      02013010120130101        A
C9295001003Injection, carfilzomib, 1 mg                                                    Injection, carfilzomib      53      A                                          1833(t)                                                    DYY20130101                O1D 1      02013010120130101        A
C9296001003Injection, ziv-aflibercept, 1 mg                                                Injection, ziv-aflibercept  53      A                                          1833(t)                                                    DYY20130101                O1D 1      02013010120130101        A
C9352001003Microporous collagen implantable tube (neuragen nerve guide), per centimeter    Neuragen nerve guide, per cm53      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N
C9352002004length
C9353001003Microporous collagen implantable slit tube (neurawrap nerve protector), per     Neurawrap nerve protector,cm53      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N
C9353002004centimeter length
C9354001003Acellular pericardial tissue matrix of non-human origin (veritas), per square   Veritas collagen matrix, cm253      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N
C9354002004centimeter
C9355001003Collagen nerve cuff (neuromatrix), per 0. 5 centimeter length                   Neuromatrix nerve cuff, cm  53      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N
C9356001003Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix     TenoGlide tendon prot, cm2  53      A                                          621 MMA                                                    D                          D1A 9      02008070120080701        N
C9356002004(tenoglide tendon protector sheet), per square centimeter
C9358001003Dermal substitute, native, non-denatured collagen, fetal bovine origin          SurgiMend, fetal            53      A                                          621  MMA                                                   DYY20080701                D1A 9      02008070120080701        N
C9358002004(surgimend collagen matrix), per 0. 5 square centimeters
C9359001003Porous purified collagen matrix bone void filler (integra mozaik                Implnt,bon void filler-putty53      A                                          1833(T)                                                    D                          D1A 9      02008100120081001        N
C9359002004osteoconductive scaffold putty, integra os osteoconductive scaffold putty), per
C93590030040. 5 cc
C9360001003Dermal substitute, native, non-denatured collagen, neonatal bovine origin       SurgiMend, neonatal         53      A                                          621MMA                                                     DYY20090701                D1A 9      02009070120090701        N
C9360002004(surgimend collagen matrix), per 0. 5 square centimeters
C9361001003Collagen matrix nerve wrap (neuromend collagen nerve wrap), per 0. 5 centimeter NeuroMend nerve wrap        53      A                                          621MMA                                                     D                          D1A 9      02009070120090701        N
C9361002004length
C9362001003Porous purified collagen matrix bone void filler (integra mozaik                Implnt,bon void filler-strip53      A                                          621MMA                                                     D                          D1A 9      02009070120090701        N
C9362002004osteoconductive scaffold strip), per 0. 5 cc
C9363001003Skin substitute, integra meshed bilayer wound matrix, per square centimeter     Integra Meshed Bil Wound Mat53      A                                          621MMA                                                     DYY20090701                D1A 9      02009070120090701        N
C9364001003Porcine implant, permacol, per square centimeter                                Porcine implant, Permacol   53      A                                          621MMA                                                     D                          D1A 9      02009070120090701        N
C9365001003Oasis ultra tri-layer matrix, per square centimeter                             Oasis Ultra Tri-Layer Matrix53      A                                          1833(t)                           Q4124                    D                      0093O1E 9      0201107012012010120111231N
C9366001003Epifix, per square centimeter                                                   EpiFix wound cover          53      A                                          1833(t)                           Q4131                    D                          O1E 1      0201201012013010120121231D
C9367001003Skin substitute, endoform dermal template, per square centimeter                Endoform Dermal Template    53      A                                          1833(t)(6)                                                 DYY20100701            0093O1E 9      02010070120100701        N
C9368001003Grafix core, per square centimeter                                              Grafix core                 53      A                                          1883(t)                           Q4132                    D                          O1E 1      0201207012013010120121231D
C9369001003Grafix prime, per square centimeter                                             Grafix prime                53      A                                          1833(t)                           Q4133                    D                          O1E 1      0201207012013010120121231D
C9399001003Unclassified drugs or biologicals                                               Unclassified drugs or biolog53      A                                          621MMA                                                     DYY20080101                O1E 1      02004010120040101        N
C9406001003Iodine i-123 ioflupane, diagnostic, per study dose, up to 5 millicuries         Dx I-123 ioflupane, per dose53      A                                          1833(t)                           A9584                    D                      0093O1E 4      0201107012012010120111231N
C9600001003Percutaneous transcatheter placement of drug eluting intracoronary stent(s),    Perc drug-el cor stent sing 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9600002004with coronary angioplasty when performed;single major coronary artery or branch
C9601001003Percutaneous transcatheter placement of drug-eluting intracoronary stent(s),    Perc drug-el cor stent bran 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9601002004with coronary angioplasty when performed; each additional branch of a major
C9601003004coronary artery (list separately in addition to code for primary procedure)
C9602001003Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary Perc d-e cor stent ather s  53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9602002004stent, with coronary angioplasty when performed;single major coronary artery
C9602003004or branch
C9603001003Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary Perc d-e cor stent ather br 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9603002004stent, with coronary angioplasty when performed;each additional branch of a
C9603003004major coronary artery (list separately in addition to code for primary
C9603004004procedure)
C9604001003Percutaneous transluminal revascularization of or through coronary artery       Perc d-e cor revasc t cabg s53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9604002004bypass graft (internal mammary, free arterial, venous), any combination of
C9604003004drug-eluting intracoronary stent, atherectomy and angioplasty, including distal
C9604004004protection when performed;single vessel
C9605001003Percutaneous transluminal revascularization of or through coronary artery       Perc d-e cor revasc t cabg b53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9605002004bypass graft (internal mammary, free arterial, venous), any combination of
C9605003004drug-eluting intracoronary stent, atherectomy and angioplasty, including distal
C9605004004protection when performed; each additional branch subtended by the bypass
C9605005004graft (list separately in addition to code for primary procedure)
C9606001003Percutaneous transluminal revascularization of acute total/subtotal occlusion   Perc d-e cor revasc w AMI s 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9606002004during acute myocardial infarction, coronary artery or coronary artery bypass
C9606003004graft, any combination of drug-eluting intracoronary stent, atherectomy and
C9606004004angioplasty, including aspiration thrombectomy when performed, single vessel
C9607001003Percutaneous transluminal revascularization of chronic total occlusion,         Perc d-e cor revasc chro sin53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9607002004coronary artery, coronary artery branch, or coronary artery bypass graft, any
C9607003004combination of drug-eluting intracoronary stent, atherectomy and
C9607004004angioplasty;single vessel
C9608001003Percutaneous transluminal revascularization of chronic total occlusion,         Perc d-e cor revasc chro add53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        A
C9608002004coronary artery, coronary artery branch, or coronary artery bypass graft, any
C9608003004combination of drug-eluting intracoronary stent, atherectomy and angioplasty;
C9608004004each additional coronary artery, coronary artery branch, or bypass graft (list
C9608005004separately in addition to code for primary procedure)
C9716001003Creations of thermal anal lesions by radiofrequency energy                      Radiofrequency energy to anu53      A                                          1833(t)                                                    D                          P6D 2      0200407012012010120111231N
C9724001003Endoscopic full-thickness plication of the stomach using endoscopic plication   EPS stomach plic            53      A                                          1833(T)                                                    DYY20080101                P8I 2      02005040120130101        C
C9724002004system (eps); includes endoscopy
C9725001003Placement of endorectal intracavitary applicator for high intensity             Place endorectal app        53      A                                          1833(T)                                                    DYY20080101                P7A 6      02005100120051001        N
C9725002004brachytherapy
C9726001003Placement and removal (if performed) of applicator into breast for radiation    Rxt breast appl place/remov 53      A                                          1833(T)                                                    DYY20080101                P7A 6      02006010120060101        N
C9726002004therapy
C9727001003Insertion of implants into the soft palate; minimum of three implants           Insert palate implants      53      A                                          1833(T)                                                    DYY20080101                P6D 2      02006100120061001        N
C9728001003Placement of interstitial device(s) for radiation therapy/surgery guidance (eg, Place device/marker, non pro53      A                                          1833(T)                                                    DYY20130101                P5E 2      02007070120100101        N
C9728002004fiducial markers, dosimeter), for other than the following sites (any
C9728003004approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or
C9728004004multiple
C9729001003Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression   Percut lumbar lami          53      A                                          1833(t)                                                    D                      0093P1F 2      020110401        20110630N
C9729002004of neural elements, (with ligamentous resection, discectomy, facetectomy and/or
C9729003004foraminotomy, when performed) any method under indirect image guidance, with
C9729004004the use of an endoscope when performed, single or multiple levels, unilateral
C9729005004or bilateral; lumbar
C9730001003Bronchoscopic bronchial thermoplasty with imaging guidance (if performed),      Bronchial thermo, 1 lobe    53      A                                          1833(t)                           0276T                    D                      0093P8F 2      0201107012012010120111231N
C9730002004radiofrequency ablation of airway smooth muscle, 1 lobe
C9731001003Bronchoscopic bronchial thermoplasty with imaging guidance (if performed),      Bronchial thermo, >1 lobe   53      A                                          1833(t)                           0277T                    D                      0093P8F 2      0201107012012010120111231N
C9731002004radiofrequency ablation of airway smooth muscle, 2 or more lobes
C9732001003Insertion of ocular telescope prosthesis including removal of crystalline lens  Insert ocular telescope pros53      A                                          1833(t)                           0308T                    DYY20120101                P4E 2      0201201012012070120120630D
C9733001003Non-ophthalmic fluorescent vascular angiography                                 Non-ophthalmic FVA          53      A                                          1833(t)                                                    D                          I4B 4      02012040120120401        A
C9800001003Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and       Dermal filler inj px/suppl  53      A                                          1833(t)                                                    DYY20100323            0093P6A 1      02010070120100701        N
C9800002004provision of radiesse or sculptra dermal filler, including all items and
C9800003004supplies
C9801001003Smoking and tobacco cessation counseling visit for the asymptomatic patient;    Tobacco-use counsel 3-10 min53      A                                          101 MIPAA                         G0436                    D                          M5D 1      0201008252011010120101231N
C9801002004intermediate, greater than 3 minutes, up to 10 minutes
C9802001003Smoking and tobacco cessation counseling visit for the asymptomatic patient;    Tobacco-use counsel >10min  53      A                                          101 MIPPA                         G0437                    D                          M5D 9      0201008252011010120101231N
C9802002004intensive, greater than 10 minutes
C9898001003Radiolabeled product provided during a hospital inpatient stay                  Inpnt stay radiolabeled item00      9                                          NA                                                         D                          Z2  1      02008010120080101        N
C9899001003Implanted prosthetic device, payable only for inpatients who do not have        Inpt implant pros dev,no cov53      A                                          1833(t)                                                    D                          Z2  1      02009010120090101        N
C9899002004inpatient coverage
E0100003003Cane, includes canes of all materials, adjustable or fixed, with tip            Cane adjust/fixed with tip  32      A60-3  60-9        2100.1                                                                             D                          D1E APR    01986010119960101        N
E0105001003Cane, quad or three prong, includes canes of all materials, adjustable or       Cane adjust/fixed quad/3 pro32      A60-15 60-9        2100.1                                                                             D                          D1E APR    01986010119960101        N
E0105002004fixed, with tips
E0110002003Crutches, forearm, includes crutches of various materials, adjustable or fixed, Crutch forearm pair         32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0110003004pair, complete with tips and handgrips
E0111001003Crutch forearm, includes crutches of various materials, adjustable or fixed,    Crutch forearm each         32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0111002004each, with tip and handgrips
E0112001003Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and         Crutch underarm pair wood   32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0112002004handgrips
E0113001003Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip    Crutch underarm each wood   32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0114001003Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips  Crutch underarm pair no wood32      A60-9              2100.1                                                                             D                          D1E APR    01986010119970101        N
E0114002004and handgrips
E0116001003Crutch, underarm, other than wood, adjustable or fixed, with pad, tip,          Crutch underarm each no wood32      A60-9              2100.1                                                                             D                          D1E APR    01986010120060101        N
E0116002004handgrip, with or without shock absorber, each
E0117001003Crutch, underarm, articulating, spring assisted, each                           Underarm springassist crutch32      A                  2100.1                                                                             D                          D1E APR    02003010120030101        N
E0118001003Crutch substitute, lower leg platform, with or without wheels, each             Crutch substitute           32      A                                                                                                     C                          D1E APR    02004010120040401        N
E0130002003Walker, rigid (pickup), adjustable or fixed height                              Walker rigid adjust/fixed ht32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0135001003Walker, folding (pickup), adjustable or fixed height                            Walker folding adjust/fixed 32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0140001003Walker, with trunk support, adjustable or fixed height, any type                Walker w trunk support      32      A60-9              2100.1                                                                             D                          D1E APR    02004010120040101        N
E0141001003Walker, rigid, wheeled, adjustable or fixed height                              Rigid wheeled walker adj/fix32      A60-9              2100.1                                                                             D                          D1E APR    01986010120040101        N
E0143001003Walker, folding, wheeled, adjustable or fixed height                            Walker folding wheeled w/o s32      A60-9              2100.1                                                                             D                          D1E APR    01986010120040101        N
E0144001003Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior   Enclosed walker w rear seat 32      A60-9              2100.1                                                                             D                          D1E APR    02000010120071005        N
E0144002004seat
E0147001003Walker, heavy duty, multiple braking system, variable wheel resistance          Walker variable wheel resist32      A60-15             2100.1                                                                             D                          D1E APR    01986010120040101        N
E0148001003Walker, heavy duty, without wheels, rigid or folding, any type, each            Heavyduty walker no wheels  32      A                                                                                                     C                          D1E APR    02001010120010101        N
E0149001003Walker, heavy duty, wheeled, rigid or folding, any type                         Heavy duty wheeled walker   32      A                                                                                                     C                          D1E APR    02001010120040101        N
E0153001003Platform attachment, forearm crutch, each                                       Forearm crutch platform atta32      A                                                                                                     C                          D1E APR    01986010119960101        N
E0154001003Platform attachment, walker, each                                               Walker platform attachment  32      A                                                                                                     C                          D1E APR    01986010119960101        N
E0155001003Wheel attachment, rigid pick-up walker, per pair                                Walker wheel attachment,pair32      A                                                                                                     C                          D1E APR    01986010120000101        N
E0156002003Seat attachment, walker                                                         Walker seat attachment      32      A                                                                                                     C                          D1E APR    01986010119960101        N
E0157001003Crutch attachment, walker, each                                                 Walker crutch attachment    32      A                                                                                                     C                          D1E APR    01986010119960101        N
E0158001003Leg extensions for walker, per set of four (4)                                  Walker leg extenders set of432      A                                                                                                     C                          D1E APR    01986010120000101        N
E0159001003Brake attachment for wheeled walker, replacement, each                          Brake for wheeled walker    32      A                                                                                                     C                          D1E APR    01997010119980101        N
E0160002003Sitz type bath or equipment, portable, used with or without commode             Sitz type bath or equipment 32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0161001003Sitz type bath or equipment, portable, used with or without commode, with       Sitz bath/equipment w/faucet32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0161002004faucet attachment/s
E0162001003Sitz bath chair                                                                 Sitz bath chair             32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0163001003Commode chair, mobile or stationary, with fixed arms                            Commode chair with fixed arm32      A60-9              2100.1                                                                             D                          D1E APR    01986010120070101        N
E0165001003Commode chair, mobile or stationary, with detachable arms                       Commode chair with detacharm36      A60-9              2100.1                                                                             D                          D1E R      01986010120070101        N
E0167001003Pail or pan for use with commode chair, replacement only                        Commode chair pail or pan   32      A60-9                                                                                                 D                          D1E APR    01986010120070101        N
E0168001003Commode chair, extra wide and/or heavy duty, stationary or mobile, with or      Heavyduty/wide commode chair32      A                                                                                                     C                          D1E APR    02001010120010101        N
E0168002004without arms, any type, each
E0170001003Commode chair with integrated seat lift mechanism, electric, any type           Commode chair electric      36      A                                                                                                     C                          D1E APR    02006010120060101        N
E0171001003Commode chair with integrated seat lift mechanism, non-electric, any type       Commode chair non-electric  36      A                                                                                                     C                          D1E APR    02006010120060101        N
E0172001003Seat lift mechanism placed over or on top of toilet, any type                   Seat lift mechanism toilet  00      9                                          1861SSA                                                    S                          D1E APR    02006010120060101        N
E0175001003Foot rest, for use with commode chair, each                                     Commode chair foot rest     32      A                                                                                                     C                          D1E APR    01986010119960101        N
E0181001003Powered pressure reducing mattress overlay/pad, alternating, with pump,         Press pad alternating w/ pum36      A60-9              4107.6                                                                             D                          D1E R      01986010120070101        N
E0181002004includes heavy duty
E0182001003Pump for alternating pressure pad, for replacement only                         Replace pump, alt press pad 36      A60-9              4107.6                                                                             D                          D1E R      01986010120070101        N
E0184001003Dry pressure mattress                                                           Dry pressure mattress       32      A60-9              4107.6                                                                             D                          D1E APR    01986010119960101        N
E0185001003Gel or gel-like pressure pad for mattress, standard mattress length and width   Gel pressure mattress pad   32      A60-9              4107.6                                                                             D                          D1E APR    01986010119980101        N
E0186001003Air pressure mattress                                                           Air pressure mattress       36      A60-9                                                                                                 D                          D1E R      01986010119960101        N
E0187001003Water pressure mattress                                                         Water pressure mattress     36      A60-9                                                                                                 D                          D1E R      01986010119960101        N
E0188001003Synthetic sheepskin pad                                                         Synthetic sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR    01986010120010101        N
E0189001003Lambswool sheepskin pad, any size                                               Lambswool sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR    01986010120010101        N
E0190001003Positioning cushion/pillow/wedge, any shape or size, includes all components    Positioning cushion         00      9                  2100.1                                                                             D                          D1E 9      02004010120070101        N
E0190002004and accessories
E0191001003Heel or elbow protector, each                                                   Protector heel or elbow     32      A                                                                                                     C                          D1E APR    01986010119960101        N
E0193001003Powered air flotation bed (low air loss therapy)                                Powered air flotation bed   36      A                                                                                                     C                          D1E R      01990010119930101        N
E0194001003Air fluidized bed                                                               Air fluidized bed           36      A60-19                                                                                                D                      0013D1E R      01991010119910101        N
E0196001003Gel pressure mattress                                                           Gel pressure mattress       36      A60-9                                                                                                 D                          D1E R      01991010119910101        N
E0197001003Air pressure pad for mattress, standard mattress length and width               Air pressure pad for mattres32      A60-9                                                                                                 D                          D1E APR    01991010119980101        N
E0198001003Water pressure pad for mattress, standard mattress length and width             Water pressure pad for mattr32      A60-9                                                                                                 D                          D1E APR    01991010119980101        N
E0199001003Dry pressure pad for mattress, standard mattress length and width               Dry pressure pad for mattres32      A60-9                                                                                                 D                          D1E APR    01991010119980101        N
E0200002003Heat lamp, without stand (table model), includes bulb, or infrared element      Heat lamp without stand     32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0202001003Phototherapy (bilirubin) light with photometer                                  Phototherapy light w/ photom36      A                                                                                                     C                          D1E R      01985010119960101        N
E0203001003Therapeutic lightbox, minimum 10,000 lux, table top model                       Therapeutic lightbox tabletp00      960-9                                                                                                 M                          D1E 9      02003010120050101        N
E0205001003Heat lamp, with stand, includes bulb, or infrared element                       Heat lamp with stand        32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N
E0210001003Electric heat pad, standard                                                     Electric heat pad standard  32      A60-9                                                                                                 D                          D1E ALPR   01986010120030101        N
E0215001003Electric heat pad, moist                                                        Electric heat pad moist     32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0217001003Water circulating heat pad with pump                                            Water circ heat pad w pump  32      A60-9                                                                                                 D                          D1E APR    01997010119970101        N
E0218001003Water circulating cold pad with pump                                            Water circ cold pad w pump  36      A60-9                                                                                                 D                          D1E APR    01997010119970101        N
E0220001003Hot water bottle                                                                Hot water bottle            32      A                                                                                                     C                          D1E APR    0198601012011010120101231N
E0221001003Infrared heating pad system                                                     Infrared heating pad system 00      9                                                                                                     C                          D1E APR    02002010120070101        N
E0225001003Hydrocollator unit, includes pads                                               Hydrocollator unit          32      A60-9              2210.3                                                                             D                          D1E APR    01986010119960101        N
E0230001003Ice cap or collar                                                               Ice cap or collar           32      A                                                                                                     C                          D1E APR    0198601012011010120101231N
E0231001003Non-contact wound warming device (temperature control unit, ac adapter and      Wound warming device        00      9                  2303                                                                               M                          D1E R      02002010120020701        N
E0231002004power cord) for use with warming card and wound cover
E0232001003Warming card for use with the non contact wound warming device and non contact  Warming card for NWT        00      9                  2303                                                                               M                          D1E P      02002010120020701        N
E0232002004wound warming wound cover
E0235001003Paraffin bath unit, portable (see medical supply code a4265 for paraffin)       Paraffin bath unit portable 36      A60-9              2210.3                                                                             D                          D1E R      01986010119960101        N
E0236001003Pump for water circulating pad                                                  Pump for water circulating p36      A60-9                                                                                                 D                          D1E R      01986010119960101        N
E0238001003Non-electric heat pad, moist                                                    Heat pad non-electric moist 32      A60-9                                                                                                 D                          D1E APR    0198601012011010120101231N
E0239001003Hydrocollator unit, portable                                                    Hydrocollator unit portable 32      A60-9              2210.3                                                                             D                          D1E APR    01986010119960101        N
E0240002003Bath/shower chair, with or without wheels, any size                             Bath/shower chair           00      960-9                                                                                                 M                          D1E 9      02004010120060101        N
E0241001003Bath tub wall rail, each                                                        Bath tub wall rail          00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N
E0242001003Bath tub rail, floor base                                                       Bath tub rail floor         00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N
E0243001003Toilet rail, each                                                               Toilet rail                 00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N
E0244001003Raised toilet seat                                                              Toilet seat raised          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N
E0245001003Tub stool or bench                                                              Tub stool or bench          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N
E0246001003Transfer tub rail attachment                                                    Transfer tub rail attachment00      9                                                                                                     C                          D1E APR    01986010119960101        N
E0247001003Transfer bench for tub or toilet with or without commode opening                Trans bench w/wo comm open  00      960-9                                                                                                 D                          D1E APR    02004010120040101        N
E0248001003Transfer bench, heavy duty, for tub or toilet with or without commode opening   HDtrans bench w/wo comm open00      960-9                                                                                                 D                          D1E APR    02004010120040101        N
E0249001003Pad for water circulating heat unit, for replacement only                       Pad water circulating heat u32      A60-9                                                                                                 D                          D1E APR    01986010120100101        N
E0250002003Hospital bed, fixed height, with any type side rails, with mattress             Hosp bed fixed ht w/ mattres36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N
E0251001003Hospital bed, fixed height, with any type side rails, without mattress          Hosp bed fixd ht w/o mattres36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N
E0255001003Hospital bed, variable height, hi-lo, with any type side rails, with mattress   Hospital bed var ht w/ mattr36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N
E0256001003Hospital bed, variable height, hi-lo, with any type side rails, without mattressHospital bed var ht w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0260001003Hospital bed, semi-electric (head and foot adjustment), with any type side      Hosp bed semi-electr w/ matt36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N
E0260002004rails, with mattress
E0261001003Hospital bed, semi-electric (head and foot adjustment), with any type side      Hosp bed semi-electr w/o mat36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0261002004rails, without mattress
E0265001003Hospital bed, total electric (head, foot and height adjustments), with any type Hosp bed total electr w/ mat36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N
E0265002004side rails, with mattress
E0266001003Hospital bed, total electric (head, foot and height adjustments), with any type Hosp bed total elec w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N
E0266002004side rails, without mattress
E0270001003Hospital bed, institutional type includes: oscillating, circulating and stryker Hospital bed institutional t00      960-9                                                                                                 M                          D1B R      01986010119930101        N
E0270002004frame, with mattress
E0271001003Mattress, innerspring                                                           Mattress innerspring        32      A60-18 60-9                                                                                           D                          D1B APR    01986010119930101        N
E0272001003Mattress, foam rubber                                                           Mattress foam rubber        32      A60-18 60-9                                                                                           D                          D1B APR    01986010119930101        N
E0273001003Bed board                                                                       Bed board                   00      960-9                                                                                                 M                          D1B APR    01986010119890101        N
E0274001003Over-bed table                                                                  Over-bed table              00      960-9                                                                                                 M                          D1B APR    01986010119890101        N
E0275001003Bed pan, standard, metal or plastic                                             Bed pan standard            32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0276001003Bed pan, fracture, metal or plastic                                             Bed pan fracture            32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0277001003Powered pressure-reducing air mattress                                          Powered pres-redu air mattrs36      A60-9                                                                                                 D                          D1E R      01992010119980101        N
E0280001003Bed cradle, any type                                                            Bed cradle                  32      A                                                                                                     C                          D1B APR    01986010119890101        N
E0290001003Hospital bed, fixed height, without side rails, with mattress                   Hosp bed fx ht w/o rails w/m36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0291001003Hospital bed, fixed height, without side rails, without mattress                Hosp bed fx ht w/o rail w/o 36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0292001003Hospital bed, variable height, hi-lo, without side rails, with mattress         Hosp bed var ht w/o rail w/o36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0293001003Hospital bed, variable height, hi-lo, without side rails, without mattress      Hosp bed var ht w/o rail w/ 36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0294001003Hospital bed, semi-electric (head and foot adjustment), without side rails,     Hosp bed semi-elect w/ mattr36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0294002004with mattress
E0295001003Hospital bed, semi-electric (head and foot adjustment), without side rails,     Hosp bed semi-elect w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0295002004without mattress
E0296001003Hospital bed, total electric (head, foot and height adjustments). Without side  Hosp bed total elect w/ matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119920101        N
E0296002004rails, with mattress
E0297001003Hospital bed, total electric (head, foot and height adjustments), without side  Hosp bed total elect w/o mat36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N
E0297002004rails, without mattress
E0300001003Pediatric crib, hospital grade, fully enclosed, with or without top enclosure   Enclosed ped crib hosp grade32      A                                                                                                     C                          D1B APR    02004010120130101        C
E0301001003Hospital bed, heavy duty, extra wide, with weight capacity greater than 350     HD hosp bed, 350-600 lbs    36      A60-18                                                                                                D                          D1B R      02004010120040101        N
E0301002004pounds, but less than or equal to 600 pounds, with any type side rails, without
E0301003004mattress
E0302001003Hospital bed, extra heavy duty, extra wide, with weight capacity greater than   Ex hd hosp bed > 600 lbs    36      A60-18                                                                                                D                          D1B R      02004010120040101        N
E0302002004600 pounds, with any type side rails, without mattress
E0303001003Hospital bed, heavy duty, extra wide, with weight capacity greater than 350     Hosp bed hvy dty xtra wide  36      A60-18                                                                                                D                          D1B R      02004010120040101        N
E0303002004pounds, but less than or equal to 600 pounds, with any type side rails, with
E0303003004mattress
E0304001003Hospital bed, extra heavy duty, extra wide, with weight capacity greater than   Hosp bed xtra hvy dty x wide36      A60-18                                                                                                D                          D1B R      02004010120040101        N
E0304002004600 pounds, with any type side rails, with mattress
E0305002003Bed side rails, half length                                                     Rails bed side half length  36      A60-18                                                                                                D                          D1B R      01986010119900101        N
E0310001003Bed side rails, full length                                                     Rails bed side full length  32      A60-18                                                                                                D                          D1B APR    01986010119900101        N
E0315001003Bed accessory: board, table, or support device, any type                        Bed accessory brd/tbl/supprt00      960-9                                                                                                 M                          D1B APR    01986010119970101        N
E0316001003Safety enclosure frame/canopy for use with hospital bed, any type               Bed safety enclosure        36      A                                                                                                     C                          D1B APR    02002010120020101        N
E0325001003Urinal; male, jug-type, any material                                            Urinal male jug-type        32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0326001003Urinal; female, jug-type, any material                                          Urinal female jug-type      32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0328001003Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard,  Ped hospital bed, manual    36      A                                                                                                     C                          D1B R      02008010120080101        N
E0328002004footboard and side rails up to 24 inches above the spring, includes mattress
E0329001003Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, Ped hospital bed semi/elect 36      A                                                                                                     C                          D1B R      02008010120080101        N
E0329002004top of headboard, footboard and side rails up to 24 inches above the spring,
E0329003004includes mattress
E0350001003Control unit for electronic bowel irrigation/evacuation system                  Control unit bowel system   57      A                                                                                                     C                          Z2  9      01995010119950101        N
E0352001003Disposable pack (water reservoir bag, speculum, valving mechanism and           Disposable pack w/bowel syst57      A                                                                                                     C                          Z2  9      01995010119950101        N
E0352002004collection bag/box) for use with the electronic bowel irrigation/evacuation
E0352003004system
E0370002003Air pressure  elevator for heel                                                 Air elevator for heel       00      9                                                                                                     C                          D1E APR    01997010119980101        N
E0371001003Nonpowered advanced pressure reducing overlay for mattress, standard mattress   Nonpower mattress overlay   36      A                                                                                                     C                          D1E APR    01998010119980101        N
E0371002004length and width
E0372001003Powered air overlay for mattress, standard mattress length and width            Powered air mattress overlay36      A                                                                                                     C                          D1E APR    01998010119980101        N
E0373001003Nonpowered advanced pressure reducing mattress                                  Nonpowered pressure mattress36      A                                                                                                     C                          D1E APR    01998010119980101        N
E0424001003Stationary compressed gaseous oxygen system, rental; includes container,        Stationary compressed gas 0233      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N
E0424002004contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and
E0424003004tubing
E0425001003Stationary compressed gas system, purchase; includes regulator, flowmeter,      Gas system stationary compre00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N
E0425002004humidifier, nebulizer, cannula or mask, and tubing
E0430001003Portable gaseous oxygen system, purchase; includes regulator, flowmeter,        Oxygen system gas portable  00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N
E0430002004humidifier, cannula or mask, and tubing
E0431001003Portable gaseous oxygen system, rental; includes portable container, regulator, Portable gaseous 02         33      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N
E0431002004flowmeter, humidifier, cannula or mask, and tubing
E0433001003Portable liquid oxygen system, rental; home liquefier used to fill portable     Portable liquid oxygen sys  33      A                                                                                                     C                          D1C APR    02010010120100101        N
E0433002004liquid oxygen containers, includes portable containers, regulator, flowmeter,
E0433003004humidifier, cannula or mask and tubing, with or without supply reservoir and
E0433004004contents gauge
E0434001003Portable liquid oxygen system, rental; includes portable container, supply      Portable liquid 02          33      A60-4              4107.9                                                                             D                          D1C R      01993010119930101        N
E0434002004reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or
E0434003004mask, and tubing
E0435001003Portable liquid oxygen system, purchase; includes portable container, supply    Oxygen system liquid portabl00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N
E0435002004reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and
E0435003004refill adaptor
E0439001003Stationary liquid oxygen system, rental; includes container, contents,          Stationary liquid 02        33      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N
E0439002004regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing
E0440001003Stationary liquid oxygen system, purchase; includes use of reservoir, contents  Oxygen system liquid station00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N
E0440002004indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and
E0440003004tubing
E0441001003Stationary oxygen contents, gaseous, 1 month's supply = 1 unit                  Stationary O2 contents, gas 33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N
E0442001003Stationary oxygen contents, liquid, 1 month's supply = 1 unit                   Stationary O2 contents, liq 33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N
E0443001003Portable oxygen contents, gaseous, 1 month's supply = 1 unit                    Portable 02 contents, gas   33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N
E0444001003Portable oxygen contents, liquid, 1 month's supply = 1 unit                     Portable 02 contents, liquid33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N
E0445001003Oximeter device for measuring blood oxygen levels non-invasively                Oximeter non-invasive       00      9                                                                                                     C                          Z2  9      02003010120030101        N
E0446001003Topical oxygen delivery system, not otherwise specified, includes all supplies  Topical Ox Deliver sys, nos 00      9                                                                                                     M                      0170D1E 9      02011010120110101        N
E0446002004and accessories
E0450001003Volume control ventilator, without pressure support mode, may include pressure  Vol control vent invasiv int31      A60-9                                                                                                 D                          D1E R      01985010120050101        N
E0450002004control mode, used with invasive interface (e. G. , tracheostomy tube)
E0455001003Oxygen tent, excluding croup or pediatric tents                                 Oxygen tent excl croup/ped t33      A60-4              4107.9                                                                             D                          D1C R      01986010119900101        N
E0457001003Chest shell (cuirass)                                                           Chest shell                 32      A                                                                                                     C                          D1E APR    01990010120010101        N
E0459001003Chest wrap                                                                      Chest wrap                  36      A                                                                                                     C                          D1E R      01990010119960101        N
E0460001003Negative pressure ventilator;  portable or stationary                           Neg press vent portabl/statn31      A60-9                                                                                                 D                          D1E R      01990010119960101        N
E0461001003Volume control ventilator, without pressure support mode, may include pressure  Vol control vent noninv int 31      A60-9                                                                                                 D                          D1E R      02003010120050101        N
E0461002004control mode,  used with non-invasive interface (e. G. Mask)
E0462001003Rocking bed with or without side rails                                          Rocking bed w/ or w/o side r36      A                                                                                                     C                          D1B R      01990010119960101        N
E0463001003Pressure support ventilator with volume control mode, may include pressure      Press supp vent invasive int31      A                                                                                                     C                          D1E R      02005010120050101        N
E0463002004control mode, used with invasive interface (e. G. Tracheostomy tube)
E0464001003Pressure support ventilator with volume control mode, may include pressure      Press supp vent noninv int  31      A                                                                                                     C                          D1E R      02005010120050101        N
E0464002004control mode, used with non-invasive interface (e. G. Mask)
E0470001003Respiratory assist device, bi-level pressure capability, without backup rate    RAD w/o backup non-inv intfc36      A60-9                                                                                                 D                          D1E R      02004010120040101        N
E0470002004feature, used with noninvasive interface, e. G. , nasal or facial mask
E0470003004(intermittent assist device with continuous positive airway pressure device)
E0471001003Respiratory assist device, bi-level pressure capability, with back-up rate      RAD w/backup non inv intrfc 36      A60-9                                                                                                 D                          D1E R      02004010120060401        N
E0471002004feature, used with noninvasive interface, e. G. , nasal or facial mask
E0471003004(intermittent assist device with continuous positive airway pressure device)
E0472001003Respiratory assist device, bi-level pressure capability, with backup rate       RAD w backup invasive intrfc36      A60-9                                                                                                 D                          D1E R      02004010120060401        N
E0472002004feature, used with invasive interface, e. G. , tracheostomy tube (intermittent
E0472003004assist device with continuous positive airway pressure device)
E0480001003Percussor, electric or pneumatic, home model                                    Percussor elect/pneum home m36      A60-9                                                                                                 D                          D1E R      01986010119960101        N
E0481001003Intrapulmonary percussive ventilation system and related accessories            Intrpulmnry percuss vent sys00      960-21                                                                                                M                          D1E APR    02002010120020701        N
E0482001003Cough stimulating device, alternating positive and negative airway pressure     Cough stimulating device    36      A                                                                                                     C                          D1E R      02002010120020101        N
E0483001003High frequency chest wall oscillation air-pulse generator system, (includes     Chest compression gen system36      A                                                                                                     C                          D1E R      02003010120030101        N
E0483002004hoses and vest), each
E0484001003Oscillatory positive expiratory pressure device, non-electric, any type, each   Non-elec oscillatory pep dvc32      A                                                                                                     C                          D1E APR    02003010120030101        N
E0485001003Oral device/appliance used to reduce upper airway collapsibility, adjustable or Oral device/appliance prefab32      A                                                                                                     C                          D1E P      02006010120060101        N
E0485002004non-adjustable, prefabricated, includes fitting and adjustment
E0486001003Oral device/appliance used to reduce upper airway collapsibility, adjustable or Oral device/appliance cusfab32      A                                                                                                     C                          D1E P      02006010120060101        N
E0486002004non-adjustable, custom fabricated, includes fitting and adjustment
E0487001003Spirometer, electronic, includes all accessories                                Electronic spirometer       00      9                                                                                                     D                      0156Z2  APR    02009010120090101        N
E0500002003Ippb machine,  all types, with built-in nebulization; manual or automatic       Ippb all types              31      A60-9                                                                                                 D                          D1E R      01986010119960101        N
E0500003004valves; internal or external power source
E0550003003Humidifier, durable for extensive supplemental humidification during ippb       Humidif extens supple w ippb33      A60-9                                                                                                 D                          D1E R      01986010120050701        N
E0550004004treatments or oxygen delivery
E0555001003Humidifier, durable, glass or autoclavable plastic bottle type, for use with    Humidifier for use w/ regula33      A60-9              4107.9                                                                             D                          D1C PR     01986010119960101        N
E0555002004regulator or flowmeter
E0560001003Humidifier, durable for supplemental humidification during ippb treatment or    Humidifier supplemental w/ i33      A60-9                                                                                                 D                          D1E APR    01986010120050701        N
E0560002004oxygen delivery
E0561001003Humidifier, non-heated, used with positive airway pressure device               Humidifier nonheated w PAP  32      A                                                                                                     C                          D1E APR    02004010120040101        N
E0562001003Humidifier, heated, used with positive airway pressure device                   Humidifier heated used w PAP32      A                                                                                                     C                          D1E APR    02004010120040101        N
E0565001003Compressor, air power source for equipment which is not self- contained or      Compressor air power source 36      A                                                                                                     C                          D1E R      01982010119960101        N
E0565002004cylinder driven
E0570001003Nebulizer, with compressor                                                      Nebulizer with compression  36      A60-9              4107.9                                                                             D                          D1E R      01986010119960101        N
E0571001003Aerosol compressor, battery powered, for use with small volume nebulizer        Aerosol compressor for svneb00      9                                                                                                     I                          D1E APR    0200101012012010120111231N
E0572001003Aerosol compressor, adjustable pressure, light duty for intermittent use        Aerosol compressor adjust pr36      A                                                                                                     C                          D1E APR    02001010120010101        N
E0574001003Ultrasonic/electronic aerosol generator with small volume nebulizer             Ultrasonic generator w svneb36      A                                                                                                     C                          D1E APR    02001010120030101        N
E0575001003Nebulizer, ultrasonic, large volume                                             Nebulizer ultrasonic        31      A60-9                                                                                                 D                          D1E R      01986010120010101        N
E0580001003Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with    Nebulizer for use w/ regulat32      A60-9              4107.9                                                                             D                          D1E PR     01986010119980101        N
E0580002004regulator or flowmeter
E0585001003Nebulizer, with compressor and heater                                           Nebulizer w/ compressor & he36      A60-9              4107.9                                                                             D                          D1E R      01986010119960101        N
E0600002003Respiratory suction pump, home model, portable or stationary, electric          Suction pump portab hom modl36      A60-9                                                                                                 D                          D1E R      01986010120020101        N
E0601001003Continuous airway pressure (cpap) device                                        Cont airway pressure device 36      A60-17                                                                                                D                          D1E R      01988010119960101        N
E0602001003Breast pump, manual, any type                                                   Manual breast pump          32      A                                                                                                     C                          D1E 9      02000010120020101        N
E0603001003Breast pump, electric (ac and/or dc), any type                                  Electric breast pump        00      9                                                                                                     C                          Z2  9      02002010120020101        N
E0604001003Breast pump, hospital grade, electric (ac and / or dc), any type                Hosp grade elec breast pump 00      9                                                                                                     C                          Z2  9      02002010120080101        N
E0605001003Vaporizer, room type                                                            Vaporizer room type         32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0606001003Postural drainage board                                                         Drainage board postural     36      A60-9                                                                                                 D                          D1E R      01986010119960101        N
E0607002003Home blood glucose monitor                                                      Blood glucose monitor home  32      A60-11                                                                                                D                          D1E APR    01986010119960101        N
E0610001003Pacemaker monitor, self-contained, (checks battery depletion, includes audible  Pacemaker monitr audible/vis32      A60-7  50-1                                                                                           D                          D1E APR    01986010119960101        N
E0610002004and visible check systems)
E0615001003Pacemaker monitor, self contained, checks battery depletion and other pacemaker Pacemaker monitr digital/vis32      A60-7  50-1                                                                                           D                          D1E APR    01986010119960101        N
E0615002004components, includes digital/visible check systems
E0616001003Implantable cardiac event recorder with memory, activator and programmer        Cardiac event recorder      00      9                                                                                                     C                          D1E 9      02000010120050401        N
E0617001003External defibrillator with integrated electrocardiogram analysis               Automatic ext defibrillator 36      A                                                                                                     C                          D1E 9R     02001010120010101        N
E0618001003Apnea monitor, without recording feature                                        Apnea monitor               00      9                                                                                                     C                          D1E R      02003010120030101        N
E0619001003Apnea monitor, with recording feature                                           Apnea monitor w recorder    00      9                                                                                                     C                          D1E R      02003010120030101        N
E0620002003Skin piercing device for collection of capillary blood, laser, each             Cap bld skin piercing laser 32      A                                                                                                     C                          D1E APR    02002010120020101        N
E0621001003Sling or seat, patient lift, canvas or nylon                                    Patient lift sling or seat  32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E0625001003Patient lift, bathroom or toilet, not otherwise classified                      Patient lift bathroom or toi00      960-9                                                                                                 M                          D1E APR    01986010120050101        N
E0627001003Seat lift mechanism incorporated into a combination lift-chair mechanism        Seat lift incorp lift-chair 32      A60-8              4107.8                                                    Q0080                    D                          D1E APR    01992010119960101        N
E0628001003Separate seat lift mechanism for use with patient owned furniture-electric      Seat lift for pt furn-electr32      A60-8              4107.8                                                    Q0078                    D                          D1E APR    01992010119960101        N
E0629001003Separate seat lift mechanism for use with patient owned furniture-non-electric  Seat lift for pt furn-non-el32      A                  4107.8                                                    Q0079                    D                          D1E APR    01992010119960101        N
E0630001003Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or    Patient lift hydraulic      36      A60-9                                                                                                 D                          D1E R      01986010120080101        N
E0630002004pad(s)
E0635001003Patient lift, electric with seat or sling                                       Patient lift electric       36      A60-9                                                                                                 D                          D1E R      01986010119960101        N
E0636001003Multipositional patient support system, with integrated lift, patient           PT support & positioning sys36      A                                                                                                     C                          D1E R      02003010120030101        N
E0636002004accessible controls
E0637001003Combination sit to stand frame/table system, any size including pediatric, with Combination sit to stand sys00      960-9                                                                                                 M                          D1E APR    02004010120120101        N
E0637002004seat lift feature, with or without wheels
E0638001003Standing frame/table system, one position (e. G. Upright, supine or prone       Standing frame sys          00      960-9                                                                                                 M                          D1E APR    02004010120120101        N
E0638002004stander), any size including pediatric, with or without wheels
E0639001003Patient lift, moveable from room to room with disassembly and reassembly,       Moveable patient lift system00      9                                                                                                     C                          Y2  9      02005010120070101        N
E0639002004includes all components/accessories
E0640001003Patient lift, fixed system, includes all components/accessories                 Fixed patient lift system   00      9                                                                                                     C                          Y2  9      02005010120070101        N
E0641001003Standing frame/table system, multi-position (e. G. Three-way stander), any size Multi-position stnd fram sys00      960-9                                                                                                 M                          D1E APR    02006010120120101        N
E0641002004including pediatric, with or without wheels
E0642001003Standing frame/table system, mobile (dynamic stander), any size including       Dynamic standing frame      00      960-9                                                                                                 M                          D1E APR    02006010120120101        N
E0642002004pediatric
E0650002003Pneumatic compressor, non-segmental home model                                  Pneuma compresor non-segment32      A60-16                                                                                                D                          D1E APR    01986010119960101        N
E0651001003Pneumatic compressor, segmental home model without calibrated gradient pressure Pneum compressor segmental  32      A60-16                                                                                                D                          D1E APR    01988010119960101        N
E0652001003Pneumatic compressor, segmental home model with calibrated gradient pressure    Pneum compres w/cal pressure32      A60-16                                                                                                D                          D1E APR    01988010119960101        N
E0655001003Non-segmental pneumatic appliance for use with pneumatic compressor, half arm   Pneumatic appliance half arm32      A60-16                                                                                                D                          D1E APR    01986010119960101        N
E0656001003Segmental pneumatic appliance for use with pneumatic compressor, trunk          Segmental pneumatic trunk   32      A                                                                                                     D                      0125D1E APR    02009010120090101        N
E0657001003Segmental pneumatic appliance for use with pneumatic compressor, chest          Segmental pneumatic chest   32      A                                                                                                     D                      0125D1E APR    02009010120090101        N
E0660001003Non-segmental pneumatic appliance for use with pneumatic compressor, full leg   Pneumatic appliance full leg32      A60-16                                                                                                D                          D1E APR    01986010119960101        N
E0665001003Non-segmental pneumatic appliance for use with pneumatic compressor, full arm   Pneumatic appliance full arm32      A60-16                                                                                                D                          D1E APR    01986010119960101        N
E0666001003Non-segmental pneumatic appliance for use with pneumatic compressor, half leg   Pneumatic appliance half leg32      A60-16                                                                                                D                          D1E APR    01986010119960101        N
E0667001003Segmental pneumatic appliance for use with pneumatic compressor, full leg       Seg pneumatic appl full leg 32      A60-16                                                                                                D                          D1E APR    01988010119960101        N
E0668001003Segmental pneumatic appliance for use with pneumatic compressor, full arm       Seg pneumatic appl full arm 32      A60-16                                                                                                D                          D1E APR    01988010119960101        N
E0669001003Segmental pneumatic appliance for use with pneumatic compressor, half leg       Seg pneumatic appli half leg32      A60-16                                                                                                D                          D1E APR    01994010119940101        N
E0670001003Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2  Seg pneum int legs/trunk    32      A60-16                                                                                                D                          D1E APR    02013010120130101        A
E0670002004full legs and trunk
E0671001003Segmental gradient pressure pneumatic appliance, full leg                       Pressure pneum appl full leg32      A60-16                                                                                                D                          D1E APR    01995010119950101        N
E0672001003Segmental gradient pressure pneumatic appliance, full arm                       Pressure pneum appl full arm32      A60-16                                                                                                D                          D1E APR    01995010119950101        N
E0673001003Segmental gradient pressure pneumatic appliance, half leg                       Pressure pneum appl half leg32      A60-16                                                                                                D                          D1E APR    01995010119950101        N
E0675001003Pneumatic compression device, high pressure, rapid inflation/deflation cycle,   Pneumatic compression device36      A                                                                                                     C                          D1E R      02004010120040101        N
E0675002004for arterial insufficiency (unilateral or bilateral system)
E0676001003Intermittent limb compression device (includes all accessories), not otherwise  Inter limb compress dev NOS 00      9                                                                                                     C                          D1E APR    02007010120070101        N
E0676002004specified
E0691001003Ultraviolet light therapy system, includes bulbs/lamps, timer and eye           Uvl pnl 2 sq ft or less     32      A                                                                                                     C                          D1E APR    02003010120120101        N
E0691002004protection; treatment area 2 square feet or less
E0692001003Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye     Uvl sys panel 4 ft          32      A                                                                                                     C                          D1E APR    02003010120030101        N
E0692002004protection, 4 foot panel
E0693001003Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye     Uvl sys panel 6 ft          32      A                                                                                                     C                          D1E APR    02003010120030101        N
E0693002004protection, 6 foot panel
E0694001003Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes   Uvl md cabinet sys 6 ft     32      A                                                                                                     C                          D1E APR    02003010120030101        N
E0694002004bulbs/lamps, timer and eye protection
E0700002003Safety equipment, device or accessory, any type                                 Safety equipment            00      9                                                                                                     C                          D1E APR    01986010120100101        N
E0705001003Transfer device, any type, each                                                 Transfer device             32      A                                                                                                     D                      0125D1E APR    02006010120080101        N
E0710002003Restraints, any type (body, chest, wrist or ankle)                              Restraints any type         57      A                                                                                                     C                          Z2  APR    01986010119960101        N
E0720003003Transcutaneous electrical nerve stimulation (tens) device, two lead, localized  Tens two lead               32      A35-20 35-46       4107.6                                                                             D                          D1E APR    01986010120070101        N
E0720004004stimulation
E0730001003Transcutaneous electrical nerve stimulation (tens) device, four or more leads,  Tens four lead              32      A35-20 35-46       4107.6                                                                             D                          D1E APR    01986010120070101        N
E0730002004for multiple nerve stimulation
E0731001003Form fitting conductive garment for delivery of tens or nmes (with conductive   Conductive garment for tens/34      A45-25                                                                                                D                          D1E APR    01989010119960101        N
E0731002004fibers separated from the patient's skin by layers of fabric)
E0740001003Incontinence treatment system, pelvic floor stimulator, monitor, sensor and/or  Incontinence treatment systm32      A60.24                                                                                                D                          D1E APR    01986010120010401        N
E0740002004trainer
E0744001003Neuromuscular stimulator for scoliosis                                          Neuromuscular stim for scoli36      A                                                                                                     C                          D1E R      01989010119960101        N
E0745001003Neuromuscular stimulator, electronic shock unit                                 Neuromuscular stim for shock36      A35-77                                                                                                D                          D1E R      01986010119960101        N
E0746001003Electromyography (emg), biofeedback device                                      Electromyograph biofeedback 52      A35-27                                                                                                D                          D1E APR    01989010119960101        N
E0747001003Osteogenesis stimulator, electrical, non-invasive, other than spinal            Elec osteogen stim not spine32      A35-48                                                                                                D                          D1E APR    01986010119970101        N
E0747002004applications
E0748001003Osteogenesis stimulator, electrical, non-invasive, spinal applications          Elec osteogen stim spinal   32      A35-48                                                                                                D                          D1E APR    01996010119970101        N
E0749001003Osteogenesis stimulator, electrical, surgically implanted                       Elec osteogen stim implanted36      A35-48                                                                                                D                          D1E 9      01986010120000701        N
E0755001003Electronic salivary reflex stimulator (intra-oral/non-invasive)                 Electronic salivary reflex s52      A                                                                                                     C                          Z2  APR    01990010119950401        N
E0760001003Osteogenesis stimulator, low intensity ultrasound, non-invasive                 Osteogen ultrasound stimltor32      A                  35-48                                                                              C                          D1E APR    01997010120010101        N
E0761001003Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic   Nontherm electromgntc device00      935-102                                                                                               D                          D1E 9      02003010120050101        N
E0761002004energy treatment device
E0762001003Transcutaneous electrical joint stimulation device system, includes all         Trans elec jt stim dev sys  36      A                                                                                                     C                          D1E APR    02006010120060101        N
E0762002004accessories
E0764001003Functional neuromuscular stimulation, transcutaneous stimulation of sequential  Functional neuromuscularstim32      A35-77                                                                                                D                          D1F APR    02006010120090101        N
E0764002004muscle groups of ambulation with computer control, used for walking by spinal
E0764003004cord injured, entire system, after completion of training program
E0765001003Fda approved nerve stimulator, with replaceable batteries, for treatment of     Nerve stimulator for tx n&v 32      A                                                                                                     C                          D1E APR    02001010120100101        N
E0765002004nausea and vomiting
E0769001003Electrical stimulation or electromagnetic wound treatment device, not otherwise Electric wound treatment dev00      935-102                                                                                               D                          Y2  9      02005010120050101        N
E0769002004classified
E0770001003Functional electrical stimulator, transcutaneous stimulation of nerve and/or    Functional electric stim NOS46      A                                                                                                     D                      0152D1E APR    02009010120090101        N
E0770002004muscle groups, any type, complete system, not otherwise specified
E0776001003Iv pole                                                                         Iv pole                     32      A                                                                                                     C                          D1E AEPR   01985010119950401        N
E0779001003Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater Amb infusion pump mechanical36      A                                                                                                     C                          D1E APR    02000010120000101        N
E0780001003Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours  Mech amb infusion pump <8hrs32      A                                                                                                     C                          D1E APR    02000010120000101        N
E0781001003Ambulatory infusion pump, single or multiple channels, electric or battery      External ambulatory infus pu36      A60-14                                                                                                D                          D1E 9R     01987010120000701        N
E0781002004operated, with administrative equipment, worn by patient
E0782001003Infusion pump, implantable, non-programmable (includes all components, e. G. ,  Non-programble infusion pump32      A60-14                                                                                                D                          D1E APR    01986010120030101        N
E0782002004pump, catheter, connectors, etc. )
E0783001003Infusion pump system, implantable, programmable (includes all components, e. G. Programmable infusion pump  32      A60-14                                                                                                D                          D1E APR    01995010119980101        N
E0783002004, pump, catheter, connectors, etc. )
E0784001003External ambulatory infusion pump, insulin                                      Ext amb infusn pump insulin 36      A60-14                                                                                                D                          D1E R      01996010120000701        N
E0785001003Implantable intraspinal (epidural/intrathecal) catheter used with implantable   Replacement impl pump cathet32      A                  60-14                                                                              D                          D1E P      01999010119990101        N
E0785002004infusion pump, replacement
E0786001003Implantable programmable infusion pump, replacement (excludes implantable       Implantable pump replacement32      A60-14                                                                                                D                          D1E 9      02001010120010101        N
E0786002004intraspinal catheter)
E0791001003Parenteral infusion pump, stationary, single or multi-channel                   Parenteral infusion pump sta36      A65-10             2130    4450                                                                       D                          D1E R      01989010119960101        N
E0830001003Ambulatory traction device, all types, each                                     Ambulatory traction device  00      960-9                                                                                                 D                          D1E P      02001010120010101        N
E0840003003Traction frame, attached to headboard, cervical traction                        Tract frame attach headboard32      A60-9                                                                                                 D                          D1E APR    01984010119940101        N
E0849001003Traction equipment, cervical, free-standing stand/frame, pneumatic, applying    Cervical pneum trac equip   32      A                                                                                                     C                          D1E APR    02005010120050101        N
E0849002004traction force to other than mandible
E0850001003Traction stand, free standing, cervical traction                                Traction stand free standing32      A60-9                                                                                                 D                          D1E APR    01982010119940101        N
E0855001003Cervical traction equipment not requiring additional stand or frame             Cervical traction equipment 32      A                                                                                                     C                          D1E APR    01998010119980101        N
E0856001003Cervical traction device, cervical collar with inflatable air bladder           Cervic collar w air bladder 32      A                                                                                                     C                          D1E APR    02008010120080101        N
E0860002003Traction equipment, overdoor, cervical                                          Tract equip cervical tract  32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N
E0870002003Traction frame, attached to footboard, extremity traction, (e. G. Buck's)       Tract frame attach footboard32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N
E0880001003Traction stand, free standing, extremity traction, (e. G. , buck's)             Trac stand free stand extrem32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N
E0890002003Traction frame, attached to footboard, pelvic traction                          Traction frame attach pelvic32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N
E0900001003Traction stand, free standing, pelvic traction, (e. G. , buck's)                Trac stand free stand pelvic32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N
E0910002003Trapeze bars, a/k/a patient helper, attached to bed, with grab bar              Trapeze bar attached to bed 36      A60-9                                                                                                 D                          D1E R      01986010119840101        N
E0911001003Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds,   HD trapeze bar attach to bed36      A60-9                                                                                                 D                          D1B R      02006010120060101        N
E0911002004attached to bed, with grab bar
E0912001003Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds,   HD trapeze bar free standing36      A60-9                                                                                                 D                          D1B R      02006010120060101        N
E0912002004free standing, complete with grab bar
E0920001003Fracture frame, attached to bed, includes weights                               Fracture frame attached to b36      A60-9                                                                                                 D                          D1E R      01986010119890101        N
E0930001003Fracture frame, free standing, includes weights                                 Fracture frame free standing36      A60-9                                                                                                 D                          D1E R      01986010119890101        N
E0935001003Continuous passive motion exercise device for use on knee only                  Cont pas motion exercise dev31      A60-9                                                                                                 D                          D1E R      01986010120060101        N
E0936001003Continuous passive motion exercise device for use other than knee               CPM device, other than knee 00      9                                                                                                     M                      0137D1E R      02007010120070101        N
E0940001003Trapeze bar, free standing, complete with grab bar                              Trapeze bar free standing   36      A60-9                                                                                                 D                          D1B R      01986010119890101        N
E0941001003Gravity assisted traction device, any type                                      Gravity assisted traction de36      A60-9                                                                                                 D                          D1E R      01986010119890101        N
E0942001003Cervical head harness/halter                                                    Cervical head harness/halter32      A                                                                                                     C                          D1E APR    01986010119860101        N
E0944001003Pelvic belt/harness/boot                                                        Pelvic belt/harness/boot    32      A                                                                                                     C                          D1E APR    01985010119960101        N
E0945001003Extremity belt/harness                                                          Belt/harness extremity      32      A                                                                                                     C                          D1E APR    01985010119960101        N
E0946001003Fracture, frame, dual with cross bars, attached to bed, (e. G. Balken, 4 poster)Fracture frame dual w cross 36      A60-9                                                                                                 D                          D1E R      01986010119890101        N
E0947001003Fracture frame, attachments for complex pelvic traction                         Fracture frame attachmnts pe32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N
E0948001003Fracture frame, attachments for complex cervical traction                       Fracture frame attachmnts ce32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N
E0950002003Wheelchair accessory, tray, each                                                Tray                        00      960-9                                                                                                 D                          D1D APR    01986010120040101        N
E0951001003Heel loop/holder, any type, with or without ankle strap, each                   Loop heel                   00      9                                                                                                     C                          D1D APR    01986010120050101        N
E0952001003Toe loop/holder, any type, each                                                 Toe loop/holder, each       00      960-9                                                                                                 D                          D1D APR    01986010120050101        N
E0955001003Wheelchair accessory, headrest, cushioned, any type, including fixed mounting   Cushioned headrest          32      A                                                                                                     C                          D1D APR    02004010120050101        N
E0955002004hardware, each
E0956001003Wheelchair accessory, lateral trunk or hip support, any type, including fixed   W/c lateral trunk/hip suppor32      A                                                                                                     C                          D1D APR    02004010120050101        N
E0956002004mounting hardware, each
E0957001003Wheelchair accessory, medial thigh support, any type, including fixed mounting  W/c medial thigh support    32      A                                                                                                     C                          D1D APR    02004010120050101        N
E0957002004hardware, each
E0958002003Manual wheelchair accessory, one-arm drive attachment, each                     Whlchr att- conv 1 arm drive00      960-9                                                                                                 D                          D1D R      01986010120040101        N
E0959001003Manual wheelchair accessory, adapter for amputee, each                          Amputee adapter             00      960-9                                                                                                 C                          D1D APR    01986010120040101        N
E0960001003Wheelchair accessory, shoulder harness/straps or chest strap, including any     W/c shoulder harness/straps 32      A                                                                                                     C                          D1D APR    02004010120040101        N
E0960002004type mounting hardware
E0961001003Manual wheelchair accessory, wheel lock brake extension (handle), each          Wheelchair brake extension  00      960-9                                                                                                 C                          D1D APR    01986010120040101        N
E0966001003Manual wheelchair accessory, headrest extension, each                           Wheelchair head rest extensi00      960-9                                                                                                 C                          D1D APR    01986010120040101        N
E0967001003Manual wheelchair accessory, hand rim with projections, any type, each          Manual wc hand rim w project32      A60-9                                                                                                 D                          D1D APR    01986010120070101        N
E0968001003Commode seat, wheelchair                                                        Wheelchair commode seat     36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E0969001003Narrowing device, wheelchair                                                    Wheelchair narrowing device 32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N
E0970001003No. 2 footplates, except for elevating leg rest                                 Wheelchair no. 2 footplates 00      960-9                                                                        K0037K0042               I                          D1D APR    01986010120010401        N
E0971001003Manual wheelchair accessory, anti-tipping device, each                          Wheelchair anti-tipping devi00      960-9                                                                        K0021                    C                          D1D APR    01986010120060101        N
E0973001003Wheelchair accessory, adjustable height, detachable armrest, complete assembly, W/Ch access det adj armrest 00      960-9                                                                                                 D                          D1D APR    01986010120040101        N
E0973002004each
E0974001003Manual wheelchair accessory, anti-rollback device, each                         W/Ch access anti-rollback   00      960-9                                                                                                 D                          D1D APR    01986010120040101        N
E0978001003Wheelchair accessory,  positioning belt/safety belt/pelvic strap, each          W/C acc,saf belt pelv strap 32      A                                                                                                     C                          D1D APR    01986010120050101        N
E0980001003Safety vest, wheelchair                                                         Wheelchair safety vest      32      A                                                                                                     C                          D1D APR    01986010119890101        N
E0981001003Wheelchair accessory, seat upholstery, replacement only, each                   Seat upholstery, replacement32      A                                                                                                     C                          D1D APR    02004010120040101        N
E0982001003Wheelchair accessory, back upholstery, replacement only, each                   Back upholstery, replacement32      A                                                                                                     C                          D1D APR    02004010120040101        N
E0983001003Manual wheelchair accessory, power add-on to convert manual wheelchair to       Add pwr joystick            36      A                                                                                                     C                          D1D R      02004010120040101        N
E0983002004motorized wheelchair, joystick control
E0984001003Manual wheelchair accessory, power add-on to convert manual wheelchair to       Add pwr tiller              32      A                                                                                                     C                          D1D APR    02004010120040101        N
E0984002004motorized wheelchair, tiller control
E0985001003Wheelchair accessory, seat lift mechanism                                       W/c seat lift mechanism     32      A                                                                                                     C                          D1D APR    02004010120040101        N
E0986001003Manual wheelchair accessory, push activated power assist, each                  Man w/c push-rim pow assist 32      A                                                                                                     C                          D1D APR    02004010120050101        N
E0988001003Manual wheelchair accessory, lever-activated, wheel drive, pair                 Lever-activated wheel drive 36      A                                                                                                     C                          D1D R      02012010120120101        N
E0990001003Wheelchair accessory, elevating leg rest, complete assembly, each               Wheelchair elevating leg res00      960-9                                                                                                 C                          D1D APR    01986010120040101        N
E0992001003Manual wheelchair accessory, solid seat insert                                  Wheelchair solid seat insert32      A                                                                                                     C                          D1D APR    01986010120040101        N
E0994001003Arm rest, each                                                                  Wheelchair arm rest         32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N
E0995001003Wheelchair accessory, calf rest/pad, each                                       Wheelchair calf rest        00      960-9                                                                                                 C                          D1D APR    01986010120040101        N
E1002001003Wheelchair accessory, power seating system, tilt only                           Pwr seat tilt               32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1003001003Wheelchair accessory, power seating system, recline only, without shear         Pwr seat recline            32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1003002004reduction
E1004001003Wheelchair accessory, power seating system, recline only, with mechanical shear Pwr seat recline mech       32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1004002004reduction
E1005001003Wheelchair accessory, power seatng system, recline only, with power shear       Pwr seat recline pwr        32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1005002004reduction
E1006001003Wheelchair accessory, power seating system, combination tilt and recline,       Pwr seat combo w/o shear    32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1006002004without shear reduction
E1007001003Wheelchair accessory, power seating system, combination tilt and recline, with  Pwr seat combo w/shear      32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1007002004mechanical shear reduction
E1008001003Wheelchair accessory, power seating system, combination tilt and recline, with  Pwr seat combo pwr shear    32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1008002004power shear reduction
E1009001003Wheelchair accessory, addition to power seating system, mechanically linked leg Add mech leg elevation      32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1009002004elevation system, including pushrod and leg rest, each
E1010001003Wheelchair accessory, addition to power seating system, power leg elevation     Add pwr leg elevation       32      A                                                                                                     C                          D1D APR    02004010120050101        N
E1010002004system, including leg rest, pair
E1011001003Modification to pediatric size wheelchair, width adjustment package (not to be  Ped wc modify width adjustm 32      A60-9                                                                                                 D                          D1D APR    02003010120050101        N
E1011002004dispensed with initial chair)
E1014001003Reclining back, addition to pediatric size wheelchair                           Reclining back add ped w/c  32      A60-9                                                                                                 D                          D1D APR    02003010120050101        N
E1015001003Shock absorber for manual wheelchair, each                                      Shock absorber for man w/c  32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N
E1016001003Shock absorber for power wheelchair, each                                       Shock absorber for power w/c32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N
E1017001003Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, HD shck absrbr for hd man wc32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N
E1017002004each
E1018001003Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair,  HD shck absrber for hd powwc32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N
E1018002004each
E1020001003Residual limb support system for wheelchair, any type                           Residual limb support system32      A                  60-6                                                                               D                          D1D APR    02003010120130101        C
E1028001003Wheelchair accessory, manual swingaway, retractable or removable mounting       W/c manual swingaway        32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1028002004hardware for joystick, other control interface or positioning accessory
E1029001003Wheelchair accessory, ventilator tray, fixed                                    W/c vent tray fixed         32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1030002003Wheelchair accessory, ventilator tray, gimbaled                                 W/c vent tray gimbaled      32      A                                                                                                     C                          D1D APR    02004010120040101        N
E1031001003Rollabout chair, any and all types with castors 5" or greater                   Rollabout chair with casters36      A60-9                                                                                                 D                          D1D R      01990010119900101        N
E1035001003Multi-positional patient transfer system, with integrated seat, operated by     Patient transfer system <30036      A                  2100                                                                               D                          D1D R      02001010120100101        N
E1035002004care giver, patient weight capacity up to and including 300 lbs
E1036001003Multi-positional patient transfer system, extra-wide, with integrated seat,     Patient transfer system >30036      A                                                                                                     C                          D1D R      02010010120100101        N
E1036002004operated by caregiver, patient weight capacity greater than 300 lbs
E1037001003Transport chair, pediatric size                                                 Transport chair, ped size   36      A60-9                                                                                                 D                          D1D R      02003010120030101        N
E1038001003Transport chair, adult size, patient weight capacity up to and including 300    Transport chair pt wt<=300lb36      A60-9                                                                                                 D                          D1D R      02003010120060101        N
E1038002004pounds
E1039001003Transport chair, adult size, heavy duty, patient weight capacity greater than   Transport chair pt wt >300lb36      A                                                                                                     C                          D1D R      02005010120060101        N
E1039002004300 pounds
E1050002003Fully-reclining wheelchair, fixed full length arms, swing away detachable       Whelchr fxd full length arms36      A60-9                                                                                                 D                          D1D R      01986010119840101        N
E1050003004elevating leg rests
E1060001003Fully-reclining wheelchair, detachable arms, desk or full length, swing away    Wheelchair detachable arms  36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1060002004detachable elevating legrests
E1070001003Fully-reclining wheelchair, detachable arms (desk or full length) swing away    Wheelchair detachable foot r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1070002004detachable footrest
E1083001003Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg    Hemi-wheelchair fixed arms  36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1083002004rest
E1084001003Hemi-wheelchair, detachable arms desk or full length arms, swing away           Hemi-wheelchair detachable a36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1084002004detachable elevating leg rests
E1085001003Hemi-wheelchair, fixed full length arms, swing away detachable foot rests       Hemi-wheelchair fixed arms  00      960-9                                                                        K0002                    I                          D1D R      01986010120010401        N
E1086001003Hemi-wheelchair detachable arms desk or full length, swing away detachable      Hemi-wheelchair detachable a00      960-9                                                                        K0002                    I                          D1D R      01986010120010401        N
E1086002004footrests
E1087001003High strength lightweight wheelchair, fixed full length arms, swing away        Wheelchair lightwt fixed arm36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1087002004detachable elevating leg rests
E1088001003High strength lightweight wheelchair, detachable arms desk or full length,      Wheelchair lightweight det a36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1088002004swing away detachable elevating leg rests
E1089001003High strength lightweight wheelchair, fixed length arms, swing away detachable  Wheelchair lightwt fixed arm00      960-9                                                                        K0004                    I                          D1D R      01986010120010401        N
E1089002004footrest
E1090001003High strength lightweight wheelchair, detachable arms desk or full length,      Wheelchair lightweight det a00      960-9                                                                        K0004                    I                          D1D R      01986010120010401        N
E1090002004swing away detachable foot rests
E1092001003Wide heavy duty wheel chair, detachable arms (desk or full length), swing away  Wheelchair wide w/ leg rests36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1092002004detachable elevating leg rests
E1093001003Wide heavy duty wheelchair, detachable arms desk or full length arms, swing     Wheelchair wide w/ foot rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1093002004away detachable footrests
E1100002003Semi-reclining wheelchair, fixed full length arms, swing away detachable        Whchr s-recl fxd arm leg res36      A60-9                                                                                                 D                          D1D R      01986010119880101        N
E1100003004elevating leg rests
E1110001003Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg  Wheelchair semi-recl detach 36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1110002004rest
E1130002003Standard wheelchair, fixed full length arms, fixed or swing away detachable     Whlchr stand fxd arm ft rest00      960-9                                                                        K0001                    I                          D1D R      01986010120010401        N
E1130003004footrests
E1140001003Wheelchair, detachable arms, desk or full length, swing away detachable         Wheelchair standard detach a00      960-9                                                                        K0001                    I                          D1D R      01986010120010401        N
E1140002004footrests
E1150001003Wheelchair, detachable arms, desk or full length swing away detachable          Wheelchair standard w/ leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1150002004elevating legrests
E1160001003Wheelchair, fixed full length arms, swing away detachable elevating legrests    Wheelchair fixed arms       36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1161001003Manual adult size wheelchair, includes tilt in space                            Manual adult wc w tiltinspac32      A                                                                                                     C                          D1D APR    02003010120030701        N
E1170002003Amputee wheelchair, fixed full length arms, swing away detachable elevating     Whlchr ampu fxd arm leg rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1170003004legrests
E1171001003Amputee wheelchair, fixed full length arms, without footrests or legrest        Wheelchair amputee w/o leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1172001003Amputee wheelchair, detachable arms (desk or full length) without footrests or  Wheelchair amputee detach ar36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1172002004legrest
E1180001003Amputee wheelchair, detachable arms (desk or full length) swing away detachable Wheelchair amputee w/ foot r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1180002004footrests
E1190001003Amputee wheelchair, detachable arms (desk or full length) swing away detachable Wheelchair amputee w/ leg re36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1190002004elevating legrests
E1195001003Heavy duty wheelchair, fixed full length arms, swing away detachable elevating  Wheelchair amputee heavy dut36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1195002004legrests
E1200001003Amputee wheelchair, fixed full length arms, swing away detachable footrest      Wheelchair amputee fixed arm36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1220002003Wheelchair; specially sized or constructed, (indicate brand name, model number, Whlchr special size/constrc 45      A60-6                                                                                                 D                          D1D P      01986010119900101        N
E1220003004if any) and justification
E1221001003Wheelchair with fixed arm, footrests                                            Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N
E1222001003Wheelchair with fixed arm, elevating legrests                                   Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N
E1223001003Wheelchair with detachable arms, footrests                                      Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N
E1224001003Wheelchair with detachable arms, elevating legrests                             Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N
E1225001003Wheelchair accessory, manual semi-reclining back, (recline greater than 15      Manual semi-reclining back  36      A60-6                                                                                                 D                          D1D R      01986010120050101        N
E1225002004degrees, but less than 80 degrees), each
E1226001003Wheelchair accessory, manual fully reclining back, (recline greater than 80     Manual fully reclining back 00      960-9                                                                                                 D                          D1D APR    01986010120050101        N
E1226002004degrees), each
E1227001003Special height arms for wheelchair                                              Wheelchair spec sz spec ht a32      A60-6                                                                                                 D                          D1D APR    01986010119900101        N
E1228001003Special back height for wheelchair                                              Wheelchair spec sz spec ht b36      A60-6                                                                                                 D                          D1D R      01986010119900101        N
E1229001003Wheelchair, pediatric size, not otherwise specified                             Pediatric wheelchair NOS    32      A                                                                                                     C                          D1D APR    02005010120050101        N
E1230001003Power operated vehicle (three or four wheel nonhighway) specify brand name and  Power operated vehicle      32      A60-5              4107.6                                                                             D                          D1D APR    01986010119910101        N
E1230002004model number
E1231001003Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating      Rigid ped w/c tilt-in-space 32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1231002004system
E1232001003Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating    Folding ped wc tilt-in-space32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1232002004system
E1233001003Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating   Rig ped wc tltnspc w/o seat 32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1233002004system
E1234001003Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating Fld ped wc tltnspc w/o seat 32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1234002004system
E1235001003Wheelchair, pediatric size, rigid, adjustable, with seating system              Rigid ped wc adjustable     32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1236001003Wheelchair, pediatric size, folding, adjustable, with seating system            Folding ped wc adjustable   32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1237001003Wheelchair, pediatric size, rigid, adjustable, without seating system           Rgd ped wc adjstabl w/o seat32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1238001003Wheelchair, pediatric size, folding, adjustable, without seating system         Fld ped wc adjstabl w/o seat32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N
E1239001003Power wheelchair, pediatric size, not otherwise specified                       Ped power wheelchair NOS    36      A                                                                                                     C                          D1D APR    02005010120050101        N
E1240002003Lightweight wheelchair, detachable arms, (desk or full length) swing away       Whchr litwt det arm leg rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1240003004detachable, elevating legrest
E1250001003Lightweight wheelchair, fixed full length arms, swing away detachable footrest  Wheelchair lightwt fixed arm00      960-9                                                                        K0003                    I                          D1D R      01986010120010401        N
E1260001003Lightweight wheelchair, detachable arms (desk or full length) swing away        Wheelchair lightwt foot rest00      960-9                                                                        K0003                    I                          D1D R      01986010120010401        N
E1260002004detachable footrest
E1270001003Lightweight wheelchair, fixed full length arms, swing away detachable elevating Wheelchair lightweight leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1270002004legrests
E1280002003Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests Whchr h-duty det arm leg res36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1285001003Heavy duty wheelchair, fixed full length arms, swing away detachable footrest   Wheelchair heavy duty fixed 00      960-9                                                                        K0006                    I                          D1D R      01986010120010401        N
E1290001003Heavy duty wheelchair, detachable arms (desk or full length) swing away         Wheelchair hvy duty detach a00      960-9                                                                        K0006                    I                          D1D R      01986010120010401        N
E1290002004detachable footrest
E1295001003Heavy duty wheelchair, fixed full length arms, elevating legrest                Wheelchair heavy duty fixed 36      A60-9                                                                                                 D                          D1D R      01986010119890101        N
E1296001003Special wheelchair seat height from floor                                       Wheelchair special seat heig32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N
E1297001003Special wheelchair seat depth, by upholstery                                    Wheelchair special seat dept32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N
E1298001003Special wheelchair seat depth and/or width, by construction                     Wheelchair spec seat depth/w32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N
E1300002003Whirlpool, portable (overtub type)                                              Whirlpool portable          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N
E1310001003Whirlpool, non-portable (built-in type)                                         Whirlpool non-portable      32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N
E1340001003Repair or nonroutine service for durable medical equipment requiring the skill  Repair for DME, per 15 min  00      9                                                                                                     I                          D1E 9      0199701012010010120091231N
E1340002004of a technician, labor component, per 15 minutes
E1353002003Regulator                                                                       Oxygen supplies regulator   00      960-4              4107.9                                                                             D                          D1C R      01986010120090101        N
E1354001003Oxygen accessory, wheeled cart for portable cylinder or portable concentrator,  Wheeled cart, port cyl/conc 00      9                                                                                                     C                          D1C APR    02009010120090101        N
E1354002004any type, replacement only, each
E1355001003Stand/rack                                                                      Oxygen supplies stand/rack  00      960-4                                                                                                 D                          D1C R      01986010120090101        N
E1356001003Oxygen accessory, battery pack/cartridge for portable concentrator, any type,   Batt pack/cart, port conc   00      9                                                                                                     C                          D1C APR    02009010120090101        N
E1356002004replacement only, each
E1357001003Oxygen accessory, battery charger for portable concentrator, any type,          Battery charger, port conc  00      9                                                                                                     C                          D1C APR    02009010120090101        N
E1357002004replacement only, each
E1358001003Oxygen accessory, dc power adapter for portable concentrator, any type,         DC power adapter, port conc 00      9                                                                                                     I                          D1C APR    02009010120090101        N
E1358002004replacement only, each
E1372001003Immersion external heater for nebulizer                                         Oxy suppl heater for nebuliz32      A60-4                                                                                                 D                          D1E APR    01986010119960101        N
E1390001003Oxygen concentrator, single delivery port, capable of delivering 85 percent or  Oxygen concentrator         33      A60-4                                                                                                 D                          D1C R      02000010120040101        N
E1390002004greater oxygen concentration at the prescribed flow rate
E1391001003Oxygen concentrator, dual delivery port, capable of delivering 85 percent or    Oxygen concentrator, dual   33      A60-4                                                                                                 D                          D1C R      02004010120040101        N
E1391002004greater oxygen concentration at the prescribed flow rate, each
E1392001003Portable oxygen concentrator, rental                                            Portable oxygen concentrator33      A60-4                                                                                                 D                          D1C R      02006010120060101        N
E1399001003Durable medical equipment, miscellaneous                                        Durable medical equipment mi46      A                                                                                                     C                          D1E APR    01986010119960101        N
E1405001003Oxygen and water vapor enriching system with heated delivery                    O2/water vapor enrich w/heat33      A60-4              4107                                                                               D                          D1C R      01988010119900101        N
E1406001003Oxygen and water vapor enriching system without heated delivery                 O2/water vapor enrich w/o he33      A60-4              4107                                                                               D                          D1C R      01988010119900101        N
E1500001003Centrifuge, for dialysis                                                        Centrifuge                  52      A                                                                                                     D                      0017P9B L      02002010120020101        N
E1510002003Kidney, dialysate delivery syst. Kidney machine, pump recirculat- ing, air      Kidney dialysate delivry sys52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1510003004removal syst, flowrate meter, power off, heater and temperature control with
E1510004004alarm, i. V. Poles, pressure gauge, concentrate container
E1520002003Heparin infusion pump for hemodialysis                                          Heparin infusion pump       52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1530001003Air bubble detector for hemodialysis, each, replacement                         Replacement air bubble detec52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1540001003Pressure alarm for hemodialysis, each, replacement                              Replacement pressure alarm  52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1550001003Bath conductivity meter for hemodialysis, each                                  Bath conductivity meter     52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1560001003Blood leak detector for hemodialysis, each, replacement                         Replace blood leak detector 52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1570001003Adjustable chair, for esrd patients                                             Adjustable chair for esrd pt52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1575001003Transducer protectors/fluid barriers, for hemodialysis, any size, per 10        Transducer protect/fld bar  52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1580001003Unipuncture control system for hemodialysis                                     Unipuncture control system  52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1590001003Hemodialysis machine                                                            Hemodialysis machine        52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1592001003Automatic intermittent peritioneal dialysis system                              Auto interm peritoneal dialy52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1594001003Cycler dialysis machine for peritoneal dialysis                                 Cycler dialysis machine     52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1600001003Delivery and/or installation charges for hemodialysis equipment                 Deli/install chrg hemo equip52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1610001003Reverse osmosis water purification system, for hemodialysis                     Reverse osmosis h2o puri sys52      A55-1A                                                                                                D                      0017P9B L      01986010120020101        N
E1615001003Deionizer water purification system, for hemodialysis                           Deionizer H2O puri system   52      A55-1A                                                                                                D                      0017P9B L      01986010120020101        N
E1620001003Blood pump for hemodialysis, replacement                                        Replacement blood pump      52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1625001003Water softening system, for hemodialysis                                        Water softening system      52      A55-1B                                                                                                D                      0017P9B L      01986010120020101        N
E1630001003Reciprocating peritoneal dialysis system                                        Reciprocating peritoneal dia52      A                                                                                                     C                      0017P9B L      01986010120020101        N
E1632001003Wearable artificial kidney, each                                                Wearable artificial kidney  52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1634001003Peritoneal dialysis clamps, each                                                Peritoneal dialysis clamp   52      A                  4270                                                                               D                          P9B L      02004010120040101        N
E1635001003Compact (portable) travel hemodialyzer system                                   Compact travel hemodialyzer 52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1636001003Sorbent cartridges, for hemodialysis, per 10                                    Sorbent cartridges per 10   52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1637001003Hemostats, each                                                                 Hemostats for dialysis, each52      A                                                                                                     D                      0017P9B L      02002010120030101        N
E1639001003Scale, each                                                                     Dialysis scale              52      A                                                                                                     D                      0017P9B L      02002010120030101        N
E1699001003Dialysis equipment, not otherwise specified                                     Dialysis equipment noc      52      A                                                                                                     D                      0017P9B L      01986010120020101        N
E1700002003Jaw motion rehabilitation system                                                Jaw motion rehab system     32      A                                                                                                     C                          D1E APR    01993010119971020        N
E1701001003Replacement cushions for jaw motion rehabilitation system, pkg. Of 6            Repl cushions for jaw motion34      A                                                                                                     C                          D1E P      01993010119960101        N
E1702001003Replacement measuring scales for jaw motion rehabilitation system, pkg. Of 200  Repl measr scales jaw motion34      A                                                                                                     C                          D1E P      01993010119960101        N
E1800002003Dynamic adjustable elbow extension/flexion device, includes soft interface      Adjust elbow ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N
E1800003004material
E1801001003Static progressive stretch elbow device, extension and/or flexion,  with or     SPS elbow device            36      A                                                                                                     C                          D1E PR     02002010120080101        N
E1801002004without range of motion adjustment, includes all components and accessories
E1802001003Dynamic adjustable forearm pronation/supination device, includes soft interface Adjst forearm pro/sup device36      A                                                                                                     C                          D1E R      02003010120030101        N
E1802002004material
E1805001003Dynamic adjustable wrist extension / flexion device, includes soft interface    Adjust wrist ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N
E1805002004material
E1806001003Static progressive stretch wrist device, flexion and/or extension, with or      SPS wrist device            36      A                                                                                                     C                          D1E PR     02002010120080101        N
E1806002004without range of motion adjustment, includes all components and accessories
E1810001003Dynamic adjustable knee extension / flexion device, includes soft interface     Adjust knee ext/flex device 36      A                                                                                                     C                          D1E PR     01996010120020101        N
E1810002004material
E1811001003Static progressive stretch knee device, extension and/or flexion,  with or      SPS knee device             36      A                                                                                                     C                          D1E PR     02002010120080101        N
E1811002004without range of motion adjustment, includes all components and accessories
E1812001003Dynamic knee, extension/flexion device with active resistance control           Knee ext/flex w act res ctrl36      A                                                                                                     C                          D1E PR     02006010120060101        N
E1815001003Dynamic adjustable ankle extension/flexion device, includes soft interface      Adjust ankle ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N
E1815002004material
E1816001003Static progressive stretch ankle device, flexion and/or extension, with or      SPS ankle device            36      A                                                                                                     C                          D1E PR     02002010120080101        N
E1816002004without range of motion adjustment, includes all components and accessories
E1818001003Static progressive stretch forearm pronation / supination device, with or       SPS forearm device          36      A                                                                                                     C                          D1E PR     02002010120080101        N
E1818002004without range of motion adjustment, includes all components and accessories
E1820001003Replacement soft interface material, dynamic adjustable extension/flexion deviceSoft interface material     32      A                                                                                                     C                          D1E PR     01996010120020101        N
E1821001003Replacement soft interface material/cuffs for bi-directional static progressive Replacement interface SPSD  32      A                                                                                                     C                          D1E PR     02002010120020101        N
E1821002004stretch device
E1825001003Dynamic adjustable finger extension/flexion device, includes soft interface     Adjust finger ext/flex devc 36      A                                                                                                     C                          D1E PR     01996010120020101        N
E1825002004material
E1830001003Dynamic adjustable toe extension/flexion device, includes soft interface        Adjust toe ext/flex device  36      A                                                                                                     C                          D1E PR     01996010120020101        N
E1830002004material
E1831001003Static progressive stretch toe device, extension and/or flexion, with or        Static str toe dev ext/flex 36      A                                                                                                     C                          D1E PR     02011010120110101        N
E1831002004without range of motion adjustment, includes all components and accessories
E1840001003Dynamic adjustable shoulder flexion / abduction / rotation device, includes     Adj shoulder ext/flex device36      A                                                                                                     C                          D1E PR     02002010120020101        N
E1840002004soft interface material
E1841001003Static progressive stretch shoulder device, with or without range of motion     Static str shldr dev rom adj36      A                                                                                                     C                          D1E R      02005010120080101        N
E1841002004adjustment, includes all components and accessories
E1902001003Communication board, non-electronic augmentative or alternative communication   AAC non-electronic board    00      9                                                                                                     C                          Z2  APR    02002010120020101        N
E1902002004device
E2000001003Gastric suction pump, home model, portable or stationary, electric              Gastric suction pump hme mdl36      A                                                                                                     C                          D1E R      02002010120020101        N
E2100001003Blood glucose monitor with integrated voice synthesizer                         Bld glucose monitor w voice 32      A60-11                                                                                                D                          D1E APR    02002010120020101        N
E2101001003Blood glucose monitor with integrated lancing/blood sample                      Bld glucose monitor w lance 32      A60-11                                                                                                D                          D1E APR    02002010120020101        N
E2120001003Pulse generator system for tympanic treatment of inner ear endolymphatic fluid  Pulse gen sys tx endolymp fl36      A                                                                                                     C                          D1E R      02004010120040101        N
E2201002003Manual wheelchair accessory, nonstandard seat frame, width greater than or      Man w/ch acc seat w>=20"<24"32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2201003004equal to 20 inches and less than 24 inches
E2202001003Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches         Seat width 24-27 in         32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2203001003Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22   Frame depth less than 22 in 32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2203002004inches
E2204001003Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches      Frame depth 22 to 25 in     32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2205001003Manual wheelchair accessory, handrim without projections (includes ergonomic or Manual wc accessory, handrim32      A                                                                                                     C                          D1D APR    02005010120080101        N
E2205002004contoured), any type, replacement only, each
E2206001003Manual wheelchair accessory, wheel lock assembly, complete, each                Complete wheel lock assembly32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2207001003Wheelchair accessory, crutch and cane holder, each                              Crutch and cane holder      32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2208001003Wheelchair accessory, cylinder tank carrier, each                               Cylinder tank carrier       32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2209001003Accessory, arm trough, with or without hand support, each                       Arm trough each             32      A                                                                                                     C                          D1D APR    02006010120070101        N
E2210001003Wheelchair accessory, bearings, any type, replacement only, each                Wheelchair bearings         32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2211001003Manual wheelchair accessory, pneumatic propulsion tire, any size, each          Pneumatic propulsion tire   32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2212001003Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each Pneumatic prop tire tube    32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2213001003Manual wheelchair accessory, insert for pneumatic propulsion tire (removable),  Pneumatic prop tire insert  32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2213002004any type, any size, each
E2214001003Manual wheelchair accessory, pneumatic caster tire, any size, each              Pneumatic caster tire each  32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2215001003Manual wheelchair accessory, tube for pneumatic caster tire, any size, each     Pneumatic caster tire tube  32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2216001003Manual wheelchair accessory, foam filled propulsion tire, any size, each        Foam filled propulsion tire 32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2217001003Manual wheelchair accessory, foam filled caster tire, any size, each            Foam filled caster tire each32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2218001003Manual wheelchair accessory, foam propulsion tire, any size, each               Foam propulsion tire each   32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2219001003Manual wheelchair accessory, foam caster tire, any size, each                   Foam caster tire any size ea32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2220001003Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size,  Solid propulsion tire each  32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2220002004each
E2221001003Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable),    Solid caster tire each      32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2221002004any size, each
E2222001003Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated Solid caster integrated whl 32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2222002004wheel, any size, each
E2223001003Manual wheelchair accessory, valve, any type, replacement only, each            Valve replacement only each 32      A                                                                                                     C                          D1D APR    0200601012010010120091231N
E2224001003Manual wheelchair accessory, propulsion wheel excludes tire, any size, each     Propulsion whl excludes tire32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2225001003Manual wheelchair accessory, caster wheel excludes tire, any size, replacement  Caster wheel excludes tire  32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2225002004only, each
E2226001003Manual wheelchair accessory, caster fork, any size, replacement only, each      Caster fork replacement only32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2227001003Manual wheelchair accessory, gear reduction drive wheel, each                   Gear reduction drive wheel  32      A                                                                                                     C                          D1D APR    02008010120080101        N
E2228001003Manual wheelchair accessory, wheel braking system and lock, complete, each      Mwc acc, wheelchair brake   32      A                                                                                                     C                          D1D APR    02008010120080101        N
E2230001003Manual wheelchair accessory, manual standing system                             Manual standing system      00      9                                                                                                     I                          D1D APR    02009010120090101        N
E2231001003Manual wheelchair accessory, solid seat support base (replaces sling seat),     Solid seat support base     32      A                                                                                                     C                          D1D APR    02009010120090101        N
E2231002004includes any type mounting hardware
E2291001003Back, planar, for pediatric size wheelchair including fixed attaching hardware  Planar back for ped size wc 32      A                                                                                                     C                          D1D APR    02005010120060101        N
E2292001003Seat, planar, for pediatric size wheelchair including fixed attaching hardware  Planar seat for ped size wc 32      A                                                                                                     C                          D1D APR    02005010120060101        N
E2293001003Back, contoured, for pediatric size wheelchair including fixed attaching        Contour back for ped size wc32      A                                                                                                     C                          D1D APR    02005010120060101        N
E2293002004hardware
E2294001003Seat, contoured, for pediatric size wheelchair including fixed attaching        Contour seat for ped size wc32      A                                                                                                     C                          D1D APR    02005010120060101        N
E2294002004hardware
E2295001003Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating     Ped dynamic seating frame   32      A                                                                                                     C                          D1D APR    02009010120090101        N
E2295002004frame, allows coordinated movement of multiple positioning features
E2300001003Power wheelchair accessory, power seat elevation system                         Pwr seat elevation sys      32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2301001003Power wheelchair accessory, power standing system                               Pwr standing                00      9                                                                                                     C                          D1D APR    02004010120090101        N
E2310001003Power wheelchair accessory, electronic connection between wheelchair controller Electro connect btw control 32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2310002004and one power seating system motor, including all related electronics,
E2310003004indicator feature, mechanical function selection switch, and fixed mounting
E2310004004hardware
E2311001003Power wheelchair accessory, electronic connection between wheelchair controller Electro connect btw 2 sys   32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2311002004and two or more power seating system motors, including all related electronics,
E2311003004indicator feature, mechanical function selection switch, and fixed mounting
E2311004004hardware
E2312001003Power wheelchair accessory, hand or chin control interface, mini-proportional   Mini-prop remote joystick   32      A                                                                                                     C                          D1D APR    02008010120080101        N
E2312002004remote joystick, proportional, including fixed mounting hardware
E2313001003Power wheelchair accessory, harness for upgrade to expandable controller,       PWC harness, expand control 32      A                                                                                                     C                          D1D APR    02008010120080101        N
E2313002004including all fasteners, connectors and mounting hardware, each
E2321001003Power wheelchair accessory, hand control interface, remote joystick,            Hand interface joystick     32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2321002004nonproportional, including all related electronics, mechanical stop switch, and
E2321003004fixed mounting hardware
E2322001003Power wheelchair accessory, hand control interface, multiple mechanical         Mult mech switches          32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2322002004switches, nonproportional, including all related electronics, mechanical stop
E2322003004switch, and fixed mounting hardware
E2323001003Power wheelchair accessory, specialty joystick handle for hand control          Special joystick handle     32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2323002004interface, prefabricated
E2324001003Power wheelchair accessory, chin cup for chin control interface                 Chin cup interface          32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2325001003Power wheelchair accessory, sip and puff interface, nonproportional, including  Sip and puff interface      32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2325002004all related electronics, mechanical stop switch, and manual swingaway mounting
E2325003004hardware
E2326001003Power wheelchair accessory, breath tube kit for sip and puff interface          Breath tube kit             32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2327001003Power wheelchair accessory, head control interface, mechanical, proportional,   Head control interface mech 32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2327002004including all related electronics, mechanical direction change switch, and
E2327003004fixed mounting hardware
E2328001003Power wheelchair accessory, head control or extremity control interface,        Head/extremity control inter32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2328002004electronic, proportional, including all related electronics and fixed mounting
E2328003004hardware
E2329001003Power wheelchair accessory, head control interface, contact switch mechanism,   Head control nonproportional32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2329002004nonproportional, including all related electronics, mechanical stop switch,
E2329003004mechanical direction change switch, head array, and fixed mounting hardware
E2330001003Power wheelchair accessory, head control interface, proximity switch mechanism, Head control proximity switc32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2330002004nonproportional, including all related electronics, mechanical stop switch,
E2330003004mechanical direction change switch, head array, and fixed mounting hardware
E2331001003Power wheelchair accessory, attendant control, proportional, including all      Attendant control           32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2331002004related electronics and fixed mounting hardware
E2340001003Power wheelchair accessory, nonstandard seat frame width, 20-23 inches          W/c wdth 20-23 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2341001003Power wheelchair accessory, nonstandard seat frame width, 24-27 inches          W/c wdth 24-27 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2342001003Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches       W/c dpth 20-21 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2343001003Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches          W/c dpth 22-25 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2351001003Power wheelchair accessory, electronic interface to operate speech generating   Electronic SGD interface    32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2351002004device using power wheelchair control interface
E2358001003Power wheelchair accessory, group 34 non-sealed lead acid battery, each         Gr 34 nonsealed leadacid    32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2359001003Power wheelchair accessory, group 34 sealed lead acid battery, each (e. G. Gel  Gr34 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2359002004cell, absorbed glassmat)
E2360001003Power wheelchair accessory, 22 nf non-sealed lead acid battery, each            22nf nonsealed leadacid     32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2361001003Power wheelchair accessory, 22nf sealed lead acid battery, each, (e. G. Gel     22nf sealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2361002004cell, absorbed glassmat)
E2362001003Power wheelchair accessory, group 24 non-sealed lead acid battery, each         Gr24 nonsealed leadacid     32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2363001003Power wheelchair accessory, group 24 sealed lead acid battery, each (e. G. Gel  Gr24 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2363002004cell, absorbed glassmat)
E2364001003Power wheelchair accessory, u-1 non-sealed lead acid battery, each              U1nonsealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2365001003Power wheelchair accessory, u-1 sealed lead acid battery, each (e. G. Gel cell, U1 sealed leadacid battery  32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2365002004absorbed glassmat)
E2366001003Power wheelchair accessory, battery charger, single mode, for use with only one Battery charger, single mode32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2366002004battery type, sealed or non-sealed, each
E2367001003Power wheelchair accessory, battery charger, dual mode, for use with either     Battery charger, dual mode  32      A                                                                                                     C                          D1D APR    02004010120040101        N
E2367002004battery type, sealed or non-sealed, each
E2368001003Power wheelchair component, drive wheel motor, replacement only                 Pwr wc drivewheel motor repl32      A                                                                                                     C                          D1D APR    02005010120130101        C
E2369001003Power wheelchair component, drive wheel gear box, replacement only              Pwr wc drivewheel gear repl 32      A                                                                                                     C                          D1D APR    02005010120130101        C
E2370001003Power wheelchair component, integrated drive wheel motor and gear box           Pwr wc dr wh motor/gear comb32      A                                                                                                     C                          D1D APR    02005010120130101        C
E2370002004combination, replacement only
E2371001003Power wheelchair accessory, group 27 sealed lead acid battery, (e. G. Gel cell, Gr27 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2371002004absorbed glassmat), each
E2372001003Power wheelchair accessory, group 27 non-sealed lead acid battery, each         Gr27 non-sealed leadacid    32      A                                                                                                     C                          D1D APR    02006010120060101        N
E2373001003Power wheelchair accessory, hand or chin control interface, compact remote      Hand/chin ctrl spec joystick32      A                                                                                                     C                          D1D APR    02007010120080101        N
E2373002004joystick, proportional, including fixed mounting hardware
E2374001003Power wheelchair accessory, hand or chin control interface, standard remote     Hand/chin ctrl std joystick 32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2374002004joystick (not including controller), proportional, including all related
E2374003004electronics and fixed mounting hardware, replacement only
E2375001003Power wheelchair accessory, non-expandable controller, including all related    Non-expandable controller   32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2375002004electronics and mounting hardware, replacement only
E2376001003Power wheelchair accessory, expandable controller, including all related        Expandable controller, repl 32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2376002004electronics and mounting hardware, replacement only
E2377001003Power wheelchair accessory, expandable controller, including all related        Expandable controller, initl32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2377002004electronics and mounting hardware, upgrade provided at initial issue
E2378001003Power wheelchair component, actuator, replacement only                          Pw actuator replacement     32      A                                                                                                     C                          D1D APR    02013010120130101        A
E2381001003Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement   Pneum drive wheel tire      32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2381002004only, each
E2382001003Power wheelchair accessory, tube for pneumatic drive wheel tire, any size,      Tube, pneum wheel drive tire32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2382002004replacement only, each
E2383001003Power wheelchair accessory, insert for pneumatic drive wheel tire (removable),  Insert, pneum wheel drive   32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2383002004any type, any size, replacement only, each
E2384001003Power wheelchair accessory, pneumatic caster tire, any size, replacement only,  Pneumatic caster tire       32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2384002004each
E2385001003Power wheelchair accessory, tube for pneumatic caster tire, any size,           Tube, pneumatic caster tire 32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2385002004replacement only, each
E2386001003Power wheelchair accessory, foam filled drive wheel tire, any size, replacement Foam filled drive wheel tire32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2386002004only, each
E2387001003Power wheelchair accessory, foam filled caster tire, any size, replacement      Foam filled caster tire     32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2387002004only, each
E2388001003Power wheelchair accessory, foam drive wheel tire, any size, replacement only,  Foam drive wheel tire       32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2388002004each
E2389001003Power wheelchair accessory, foam caster tire, any size, replacement only, each  Foam caster tire            32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2390001003Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size,  Solid drive wheel tire      32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2390002004replacement only, each
E2391001003Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any Solid caster tire           32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2391002004size, replacement only, each
E2392001003Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated  Solid caster tire, integrate32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2392002004wheel, any size, replacement only, each
E2393001003Power wheelchair accessory, valve for pneumatic tire tube, any type,            Valve, pneumatic tire tube  32      A                                                                                                     D                      0125D1D APR    0200701012010010120091231N
E2393002004replacement only, each
E2394001003Power wheelchair accessory, drive wheel excludes tire, any size, replacement    Drive wheel excludes tire   32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2394002004only, each
E2395001003Power wheelchair accessory, caster wheel excludes tire, any size, replacement   Caster wheel excludes tire  32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2395002004only, each
E2396001003Power wheelchair accessory, caster fork, any size, replacement only, each       Caster fork                 32      A                                                                                                     D                      0125D1D APR    02007010120070101        N
E2397001003Power wheelchair accessory, lithium-based battery, each                         Pwc acc, lith-based battery 32      A                                                                                                     C                          D1D P      02008010120080101        N
E2399001003Power wheelchair accessory, not otherwise classified interface, including all   Noc interface               32      A                                                                                                     C                          D1D APR    0200401012010010120091231N
E2399002004related electronics and any type mounting hardware
E2402001003Negative pressure wound therapy electrical pump, stationary or portable         Neg press wound therapy pump36      A                                                                                                     C                          D1E R      02004010120040101        N
E2500002003Speech generating device, digitized speech, using pre-recorded messages, less   SGD digitized pre-rec <=8min32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2500003004than or equal to 8 minutes recording time
E2502001003Speech generating device, digitized speech, using pre-recorded messages,        SGD prerec msg >8min <=20min32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2502002004greater than 8 minutes but less than or equal to 20 minutes recording time
E2504001003Speech generating device, digitized speech, using pre-recorded messages,        SGD prerec msg>20min <=40min32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2504002004greater than 20 minutes but less than or equal to 40 minutes recording time
E2506001003Speech generating device, digitized speech, using pre-recorded messages,        SGD prerec msg > 40 min     32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2506002004greater than 40 minutes recording time
E2508001003Speech generating device, synthesized speech, requiring message formulation by  SGD spelling phys contact   32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2508002004spelling and access by physical contact with the device
E2510001003Speech generating device, synthesized speech, permitting multiple methods of    SGD w multi methods msg/accs32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2510002004message formulation and multiple methods of device access
E2511001003Speech generating software program, for personal computer or personal digital   SGD sftwre prgrm for PC/PDA 32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2511002004assistant
E2512001003Accessory for speech generating device, mounting system                         SGD accessory, mounting sys 32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2599001003Accessory for speech generating device, not otherwise classified                SGD accessory noc           32      A60-23                                                                                                D                          D1E APR    02004010120040101        N
E2601001003General use wheelchair seat cushion, width less than 22 inches, any depth       Gen w/c cushion wdth < 22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2602001003General use wheelchair seat cushion, width 22 inches or greater, any depth      Gen w/c cushion wdth >=22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2603001003Skin protection wheelchair seat cushion, width less than 22 inches, any depth   Skin protect wc cus wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2604001003Skin protection wheelchair seat cushion, width 22 inches or greater, any depth  Skin protect wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2605001003Positioning wheelchair seat cushion, width less than 22 inches, any depth       Position wc cush wdth <22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2606001003Positioning wheelchair seat cushion, width 22 inches or greater, any depth      Position wc cush wdth>=22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2607001003Skin protection and positioning wheelchair seat cushion, width less than 22     Skin pro/pos wc cus wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2607002004inches, any depth
E2608001003Skin protection and positioning wheelchair seat cushion, width 22 inches or     Skin pro/pos wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2608002004greater, any depth
E2609001003Custom fabricated wheelchair seat cushion, any size                             Custom fabricate w/c cushion32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2610001003Wheelchair seat cushion, powered                                                Powered w/c cushion         32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2611001003General use wheelchair back cushion, width less than 22 inches, any height,     Gen use back cush wdth <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2611002004including any type mounting hardware
E2612001003General use wheelchair back cushion, width 22 inches or greater, any height,    Gen use back cush wdth>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2612002004including any type mounting hardware
E2613001003Positioning wheelchair back cushion, posterior, width less than 22 inches, any  Position back cush wd <22in 32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2613002004height, including any type mounting hardware
E2614001003Positioning wheelchair back cushion, posterior, width 22 inches or greater, any Position back cush wd>=22in 32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2614002004height, including any type mounting hardware
E2615001003Positioning wheelchair back cushion, posterior-lateral, width less than 22      Pos back post/lat wdth <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2615002004inches, any height, including any type mounting hardware
E2616001003Positioning wheelchair back cushion, posterior-lateral, width 22 inches or      Pos back post/lat wdth>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2616002004greater, any height, including any type mounting hardware
E2617001003Custom fabricated wheelchair back cushion, any size, including any type         Custom fab w/c back cushion 32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2617002004mounting hardware
E2619001003Replacement cover for wheelchair seat cushion or back cushion, each             Replace cover w/c seat cush 32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2620001003Positioning wheelchair back cushion, planar back with lateral supports, width   WC planar back cush wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E2620002004less than 22 inches, any height, including any type mounting hardware
E2621001003Positioning wheelchair back cushion, planar back with lateral supports, width   WC planar back cush wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N
E262100200422 inches or greater, any height, including any type mounting hardware
E2622001003Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, Adj skin pro w/c cus wd<22in32      A                                                                                                     C                          D1D APR    02011010120110101        N
E2622002004any depth
E2623001003Skin protection wheelchair seat cushion, adjustable, width 22 inches or         Adj skin pro wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02011010120110101        N
E2623002004greater, any depth
E2624001003Skin protection and positioning wheelchair seat cushion, adjustable, width less Adj skin pro/pos cus<22in   32      A                                                                                                     C                          D1D APR    02011010120110101        N
E2624002004than 22 inches, any depth
E2625001003Skin protection and positioning wheelchair seat cushion, adjustable, width 22   Adj skin pro/pos wc cus>=22 32      A                                                                                                     C                          D1D APR    02011010120110101        N
E2625002004inches or greater, any depth
E2626001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Seo mobile arm sup att to wc32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2626002004wheelchair, balanced, adjustable
E2627001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Arm supp att to wc rancho ty32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2627002004wheelchair, balanced, adjustable rancho type
E2628001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Mobile arm supports reclinin32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2628002004wheelchair, balanced, reclining
E2629001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Friction dampening arm supp 32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2629002004wheelchair, balanced, friction arm support (friction dampening to proximal and
E2629003004distal joints)
E2630001003Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm    Monosuspension arm/hand supp32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2630002004and hand support, overhead elbow forearm hand sling support, yoke type
E2630003004suspension support
E2631001003Wheelchair accessory, addition to mobile arm support, elevating proximal arm    Elevat proximal arm support 32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2632001003Wheelchair accessory, addition to mobile arm support, offset or lateral rocker  Offset/lat rocker arm w/ela 32      A                                                                                                     C                          D1D APR    02012010120120101        N
E2632002004arm with elastic balance control
E2633001003Wheelchair accessory, addition to mobile arm support, supinator                 Mobile arm support supinator32      A                                                                                                     C                          D1D APR    02012010120120101        N
E8000001003Gait trainer, pediatric size, posterior support, includes all accessories and   Posterior gait trainer      00      9                                                                                                     I                          Z2  9      02005010120050101        N
E8000002004components
E8001001003Gait trainer, pediatric size, upright support, includes all accessories and     Upright gait trainer        00      9                                                                                                     I                          Z2  9      02005010120050101        N
E8001002004components
E8002001003Gait trainer, pediatric size, anterior support, includes all accessories and    Anterior gait trainer       00      9                                                                                                     I                          Z2  9      02005010120050101        N
E8002002004components
G0008001003Administration of influenza virus vaccine                                       Admin influenza virus vac   54      A                                                                                                     C                          O1G V      01994010119960101        N
G0009001003Administration of pneumococcal vaccine                                          Admin pneumococcal vaccine  54      A                                                                                                     C                          O1G V      01994010119960101        N
G0010001003Administration of hepatitis b vaccine                                           Admin hepatitis b vaccine   54      A                                                                                                     C                          O1G 1      01994010119960101        N
G0027001003Semen analysis; presence and/or motility of sperm excluding huhner              Semen analysis              21      A                                                    400                                              C                          T1H 5      01995010120031001        N
G0101001003Cervical or vaginal cancer screening; pelvic and clinical breast examination    CA screen;pelvic/breast exam11      A                                                                                                     D                      0064M1A 1      01998010119980101        N
G0102001003Prostate cancer screening; digital rectal examination                           Prostate ca screening; dre  11      A50-55             4182                                                                               D                      0079Y1  1      02000010120000101        N
G0103001003Prostate cancer screening; prostate specific antigen test (psa)                 PSA screening               21      A50-55             4182                              310                                              D                      0064T1H 5      02000010120070101        N
G0104001003Colorectal cancer screening; flexible sigmoidoscopy                             CA screen;flexi sigmoidscope11      A                                                                                                     DYY20080101            0064P8C 2      01998010119980101        N
G0105001003Colorectal cancer screening; colonoscopy on individual at high risk             Colorectal scrn; hi risk ind11      A                                                                                                     DYY19980101            0064P8D 2      01998010119980101        N
G0106001003Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy,     Colon CA screen;barium enema11      A                                                                                                     D                      0064I1D 4      01998010119980101        N
G0106002004barium enema
G0108001003Diabetes outpatient self-management training services, individual, per 30       Diab manage trn  per indiv  11      A                                                                                                     C                      0071Y1  1      01998070120010101        N
G0108002004minutes
G0109001003Diabetes outpatient self-management training services, group session (2 or      Diab manage trn ind/group   11      A                                                                                                     C                      0071Y1  1      01998070120010101        N
G0109002004more), per 30 minutes
G0117001003Glaucoma screening for high risk patients furnished by an optometrist or        Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q      02002010120031001        N
G0117002004ophthalmologist
G0118001003Glaucoma screening for high risk patient furnished under the direct supervision Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q      02002010120031001        N
G0118002004of an optometrist or ophthalomologist
G0120001003Colorectal cancer screening; alternative to g0105, screening colonoscopy,       Colon ca scrn; barium enema 11      A                                                                                                     D                      0064I1D 4      01998010119980101        N
G0120002004barium enema.
G0121001003Colorectal cancer screening; colonoscopy on individual not meeting criteria for Colon ca scrn not hi rsk ind11      A                                                                                                     DYY20010701            0064I1D 2      01998010120010701        N
G0121002004high risk
G0122001003Colorectal cancer screening; barium enema                                       Colon ca scrn; barium enema 00      9                                                                                                     M                      0064I1D 4      01998010119980101        N
G0123001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Screen cerv/vag thin layer  21      A50-20                                               630                                              D                      0045T1H 5      01998040119980401        N
G0123002004in preservative fluid, automated thin layer preparation, screening by
G0123003004cytotechnologist under physician supervision
G0124001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Screen c/v thin layer by MD 1121    C50-20                                               630                                              D                      0045T1H 5      01998040119980401        N
G0124002004in preservative fluid, automated thin layer preparation, requiring
G0124003004interpretation by physician
G0127001003Trimming of dystrophic nails, any number                                        Trim nail(s)                11      A                  2323    4120                                                                       DYY20080101                P5A 2      01998010119980101        N
G0128001003Direct (face-to-face with patient) skilled nursing services of a registered     CORF skilled nursing service99      9                                          1833(a)                                                    D                      0070Y2  1      01998040119980401        N
G0128002004nurse provided in a comprehensive outpatient rehabilitation facility, each 10
G0128003004minutes beyond the first 5 minutes
G0129001003Occupational therapy services requiring the skills of a qualified occupational  Partial hosp prog service   00      9                                                                                                     C                      0087Y1  U      02000040120080401        N
G0129002004therapist, furnished as a component of a partial hospitalization treatment
G0129003004program, per session (45 minutes or more)
G0130001003Single energy x-ray absorptiometry (sexa) bone density study, one or more       Single energy x-ray study   11      A50-44                                                                                                DYY20080101                I4B 4      01998070119980701        N
G0130002004sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)
G0141001003Screening cytopathology smears, cervical or vaginal, performed by automated     Scr c/v cyto,autosys and md 11      A                                                    630                                              C                      0045T1H 5      01999010119990101        N
G0141002004system, with manual rescreening, requiring interpretation by physician
G0143001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N
G0143002004in preservative fluid, automated thin layer preparation, with manual screening
G0143003004and rescreening by cytotechnologist under physician supervision
G0144001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010120030101        N
G0144002004in preservative fluid, automated thin layer preparation, with  screening by
G0144003004automated system, under physician supervision
G0145001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010120030101        N
G0145002004in preservative fluid, automated thin layer preparation, with  screening by
G0145003004automated system and manual rescreening under physician supervision
G0147001003Screening cytopathology smears,  cervical or vaginal, performed by automated    Scr c/v cyto, automated sys 21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N
G0147002004system under physician supervision
G0148001003Screening cytopathology smears, cervical or vaginal, performed by automated     Scr c/v cyto, autosys, rescr21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N
G0148002004system with manual rescreening
G0151001003Services performed by a qualified physical therapist in the home health or      HHCP-serv of pt,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070120110101        N
G0151002004hospice setting, each 15 minutes
G0152001003Services performed by a qualified occupational therapist in the home health or  HHCP-serv of ot,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070120110101        N
G0152002004hospice setting, each 15 minutes
G0153001003Services performed by a qualified speech-language pathologist in the home       HHCP-svs of s/l path,ea 15mn00      9                                                                                                     C                      0082Y2  1      01999070120110101        N
G0153002004health or hospice setting, each 15 minutes
G0154001003Direct skilled nursing services of a licensed nurse (lpn or rn) in the home     HHCP-svs of rn,ea 15 min    00      9                                                                                                     C                      0082Y2  1      01999070120110101        N
G0154002004health or hospice setting, each 15 minutes
G0155001003Services of clinical social worker in home health or hospice settings, each 15  HHCP-svs of csw,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070120100101        N
G0155002004minutes
G0156001003Services of home health/hospice aide in home health or hospice settings, each   HHCP-svs of aide,ea 15 min  00      9                                                                                                     C                      0082Y2  1      01999070120100101        N
G015600200415 minutes
G0157001003Services performed by a qualified physical therapist assistant in the home      HHC PT assistant ea 15      00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0157002004health or hospice setting, each 15 minutes
G0158001003Services performed by a qualified occupational therapist assistant in the home  HHC OT assistant ea 15      00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0158002004health or hospice setting, each 15 minutes
G0159001003Services performed by a qualified physical therapist, in the home health        HHC PT maint ea 15 min      00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0159002004setting, in the establishment or delivery of a safe and effective physical
G0159003004therapy maintenance program, each 15 minutes
G0160001003Services performed by a qualified occupational therapist, in the home health    HHC Occup Therapy ea 15     00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0160002004setting, in the establishment or delivery of a safe and effective occupational
G0160003004therapy maintenance program, each 15 minutes
G0161001003Services performed by a qualified speech-language pathologist, in the home      HHC SLP ea 15 min           00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0161002004health setting, in the establishment or delivery of a safe and effective
G0161003004speech-language pathology maintenance program, each 15 minutes
G0162001003Skilled services by a registered nurse (rn) for management and evaluation of    HHC RN E&M plan svs, 15 min 00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0162002004the plan of care; each 15 minutes (the patient's underlying condition or
G0162003004complication requires an rn to ensure that essential non-skilled care achieves
G0162004004its purpose in the home health or hospice setting)
G0163001003Skilled services of a licensed nurse (lpn or rn) for the observation and        HHC LPN/RN obs/asses ea 15  00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0163002004assessment of the patient's condition, each 15 minutes (the change in the
G0163003004patient's condition requires skilled nursing personnel to identify and evaluate
G0163004004the patient's need for possible modification of treatment in the home health or
G0163005004hospice setting)
G0164001003Skilled services of a licensed nurse (lpn or rn), in the training and/or        HHC lis nurse train ea 15   00      9                                                                                                     C                          Y2  1      02011010120110101        N
G0164002004education of a patient or family member, in the home health or hospice setting,
G0164003004each 15 minutes
G0166001003External counterpulsation, per treatment session                                Extrnl counterpulse, per tx 11      A35-74                                                                                                D                      0078P6C 1      02000010120000101        N
G0168001003Wound closure utilizing tissue adhesive(s) only                                 Wound closure by adhesive   00      9                                                                                                     C                          P6C 1      02000010120000101        N
G0173001003Linear accelerator based stereotactic radiosurgery, complete course of therapy  Linear acc stereo radsur com00      9                                                                                                     DYY20080101            0094P5E 2      02000080120050101        N
G0173002004in one session
G0175001003Scheduled interdisciplinary team conference (minimum of three exclusive of      OPPS Service,sched team conf00      9                                                                                                     C                      0101M6  1      02000070120000701        N
G0175002004patient care nursing staff) with patient present
G0176001003Activity therapy, such as music, dance, art or play therapies not for           OPPS/PHP;activity therapy   00      9                                                                                                     D                      0102Y2  U      02001010120010101        N
G0176002004recreation, related to the care and treatment of patient's disabling mental
G0176003004health problems, per session (45 minutes or more)
G0177001003Training and educational services related to the care and treatment of          OPPS/PHP; train & educ serv 00      9                                                                                                     D                      0102Y2  U      02001010120010101        N
G0177002004patient's disabling mental health problems per session (45 minutes or more)
G0179001003Physician re-certification for medicare-covered home health  services under a   MD recertification HHA PT   11      A                                                                                                     C                          Y1  1      02001010120010101        N
G0179002004home health plan of care (patient not present), including contacts with home
G0179003004health agency and review of reports of patient status required by physicians to
G0179004004affirm the initial implementation of the plan of care that meets patient's
G0179005004needs, per re-certification period
G0180001003Physician certification for medicare-covered home health  services under a home MD certification HHA patient11      A                                                                                                     C                      0100Y1  1      02000100120001001        N
G0180002004health plan of care (patient not present), including contacts with home health
G0180003004agency and review of reports of patient status required by physicians to affirm
G0180004004the initial implementation of the plan of care that meets patient's needs, per
G0180005004certification period
G0181001003Physician supervision of a patient receiving medicare-covered services provided Home health care supervision11      A                                                                                                     C                          Y1  1      02001010120010101        N
G0181002004by a participating home health agency (patient not present) requiring complex
G0181003004and multidisciplinary care modalities involving regular physician development
G0181004004and/or revision of care plans, review of subsequent reports of patient status,
G0181005004review of laboratory and other studies, communication (including telephone
G0181006004calls) with other health care professionals involved in the patient's care,
G0181007004integration of new information into the medical treatment plan and/or
G0181008004adjustment of medical therapy, within a calendar month, 30 minutes or more
G0182001003Physician supervision of a patient under a medicare-approved hospice (patient   Hospice care supervision    11      A                                                                                                     C                          Y1  1      02001010120010101        N
G0182002004not present) requiring complex and multidisciplinary care modalities involving
G0182003004regular physician development and/or revision of care plans, review of
G0182004004subsequent reports of patient status, review of laboratory and other studies,
G0182005004communication (including telephone calls) with other health care professionals
G0182006004involved in the patient's care, integration of new information into the medical
G0182007004treatment plan and/or adjustment of medical therapy, within a calendar month,
G018200800430 minutes or more
G0186001003Destruction of localized lesion of choroid (for example, choroidal              Dstry eye lesn,fdr vssl tech00      9                                                                                                     CYY20080101            0099P4D 2      02001010120010101        N
G0186002004neovascularization); photocoagulation, feeder vessel technique (one or more
G0186003004sessions)
G0202001003Screening mammography, producing direct digital image, bilateral, all views     Screeningmammographydigital 11      A                                                                                                     C                          I1C 1      02001040120010401        N
G0204001003Diagnostic mammography, producing direct digital image, bilateral, all views    Diagnosticmammographydigital11      A                                                                                                     C                          I1C 4      02001040120030101        N
G0206001003Diagnostic mammography, producing direct digital image, unilateral, all views   Diagnosticmammographydigital11      A                                                                                                     C                          I1C 4      02001040120030101        N
G0219001003Pet imaging whole body; melanoma for non-covered indications                    PET img wholbod melano nonco00      950-36             4173                                                                               M                          I4B 4      02001070120010701        N
G0235001003Pet imaging, any site, not otherwise specified                                  PET not otherwise specified 00      950-36                                                                                                M                          T2D 1      02006010120060101        N
G0237001003Therapeutic procedures to increase strength or endurance of respiratory         Therapeutic procd strg endur11      A                                                                                                     C                          P6C 1UW    02002010120041001        N
G0237002004muscles, face to face, one on one, each 15 minutes (includes monitoring)
G0238001003Therapeutic procedures to improve respiratory function, other than described by Oth resp proc, indiv        11      A                                                                                                     C                          P6C 1UW    02002010120041001        N
G0238002004g0237, one on one, face to face, per 15 minutes (includes monitoring)
G0239001003Therapeutic procedures to improve respiratory function or increase strength or  Oth resp proc, group        11      A                                                                                                     C                          P6C 1UW    02002010120041001        N
G0239002004endurance of respiratory muscles, two or more individuals (includes monitoring)
G0245001003Initial physician evaluation and management of a diabetic patient with diabetic Initial foot exam pt lops   11      A50.81                                                                                                D                          M1A 1      02002070120020701        N
G0245002004sensory neuropathy resulting in a loss of protective sensation (lops) which
G0245003004must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical
G0245004004examination that consists of at least the following elements: (a) visual
G0245005004inspection of the forefoot, hindfoot and toe web spaces, (b)evaluation of a
G0245006004protective sensation, (c) evaluation of foot structure and biomechanics, (d)
G0245007004evaluation of vascular status and skin integrity, and (e) evaluation and
G0245008004recommendation of footwear and (4) patient education
G0246001003Follow-up physician evaluation and management of a diabetic patient with        Followup eval of foot pt lop11      A50.81                                                                                                D                          M1B 1      02002070120020701        N
G0246002004diabetic sensory neuropathy resulting in a loss of protective sensation (lops)
G0246003004to include at least the following: (1) a patient history, (2) a physical
G0246004004examination that includes: (a) visual inspection of the forefoot, hindfoot and
G0246005004toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot
G0246006004structure and biomechanics, (d) evaluation of vascular status and skin
G0246007004integrity, and (e) evaluation and recommendation of footwear, and (3) patient
G0246008004education
G0247001003Routine foot care by a physician of a diabetic patient with diabetic sensory    Routine footcare pt w lops  11      A50.81                                                                                                DYY20080101                M1B 1      02002070120030701        N
G0247002004neuropathy resulting in a loss of protective sensation (lops) to include, the
G0247003004local care of superficial wounds (i. E. Superficial to muscle and fascia) and
G0247004004at least the following if present: (1) local care of superficial wounds, (2)
G0247005004debridement of corns and calluses, and (3) trimming and debridement of nails
G0248001003Demonstration, prior to initiation of home inr monitoring, for patient with     Demonstrate use home inr mon11      A50.55                                                                                                D                          M1A 5      02002070120080319        N
G0248002004either mechanical heart valve(s), chronic atrial fibrillation, or venous
G0248003004thromboembolism who meets medicare coverage criteria, under the direction of a
G0248004004physician; includes: face-to-face demonstration of use and care of the inr
G0248005004monitor, obtaining at least one blood sample, provision of instructions for
G0248006004reporting home inr test results, and documentation of patient's ability to
G0248007004perform testing and report results
G0249001003Provision of test materials and equipment for home inr monitoring of patient    Provide INR test mater/equip11      A50.55                                                                                                D                          Y1  5      02002070120080319        N
G0249002004with either mechanical heart valve(s), chronic atrial fibrillation, or venous
G0249003004thromboembolism who meets medicare coverage criteria; includes: provision of
G0249004004materials for use in the home and reporting of test results to physician;
G0249005004testing not occurring more frequently than once a week; testing materials,
G0249006004billing units of service include 4 tests
G0250001003Physician review, interpretation, and patient management of home inr testing    MD INR test revie inter mgmt11      A50.55                                                                                                D                          M1B 1      02002070120080319        N
G0250002004for patient with either mechanical heart valve(s), chronic atrial fibrillation,
G0250003004or venous thromboembolism who meets medicare coverage criteria; testing not
G0250004004occurring more frequently than once a week; billing units of service include 4
G0250005004tests
G0251001003Linear accelerator based stereotactic radiosurgery, delivery including          Linear acc based stero radio00      9                                                                                                     DYY20080101            0107I1F 4      02002040120020401        N
G0251002004collimator changes and custom plugging, fractionated treatment, all lesions,
G0251003004per session, maximum five sessions per course of treatment
G0252001003Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of  PET imaging initial dx      00      950-36                                                                                                M                          I2D 4      02002100120021001        N
G0252002004breast cancer and/or surgical planning for breast cancer (e. G. Initial staging
G0252003004of axillary lymph nodes)
G0255001003Current perception threshold/sensory nerve conduction test, (snct) per limb,    Current percep threshold tst00      950-57                                                                                                M                          T2D 4      02002100120021001        N
G0255002004any nerve
G0257001003Unscheduled or emergency dialysis treatment for an esrd patient in a hospital   Unsched dialysis ESRD pt hos00      9                                                                                                     D                      0107P6D 1      02003010120030101        N
G0257002004outpatient department that is not certified as an esrd facility
G0259001003Injection procedure for sacroiliac joint; arthrograpy                           Inject for sacroiliac joint 00      9                                                                                                     D                      0107O1E 1      02003010120030101        N
G0260001003Injection procedure for sacroiliac joint; provision of anesthetic, steroid      Inj for sacroiliac jt anesth00      9                                                                                                     DYY20030101            0107O1E F      02003010120041001        N
G0260002004and/or other therapeutic agent, with or without arthrography
G0268001003Removal of impacted cerumen (one or both ears) by physician on same date of     Removal of impacted wax md  11      A                                                                                                     C                          P6C 2      02003010120030101        N
G0268002004service as audiologic function testing
G0269001003Placement of occlusive device into either a venous or arterial access site,     Occlusive device in vein art00      9                                                                                                     D                      0108P6D 1      02003010120030101        N
G0269002004post surgical or interventional procedure (e. G. Angioseal plug, vascular plug)
G0270001003Medical nutrition therapy; reassessment and subsequent intervention(s)          MNT subs tx for change dx   11      A                                                                                                     C                          M5D 1      02003010120030101        N
G0270002004following second referral in same year for change in diagnosis, medical
G0270003004condition or treatment regimen (including additional hours needed for renal
G0270004004disease), individual, face to face with the patient, each 15 minutes
G0271001003Medical nutrition therapy, reassessment and subsequent intervention(s)          Group MNT 2 or more 30 mins 11      A                                                                                                     C                          M5D 1      02003010120030101        N
G0271002004following second referral in same year for change in diagnosis, medical
G0271003004condition, or treatment regimen (including additional hours needed for renal
G0271004004disease), group (2 or more individuals), each 30 minutes
G0275001003Renal angiography, non-selective, one or both kidneys, performed at the same    Renal angio, cardiac cath   11      A                                                                                                     C                          I4A 2      02003010120080101        N
G0275002004time as cardiac catheterization and/or coronary angiography, includes
G0275003004positioning or placement of any catheter in the abdominal aorta at or near the
G0275004004origins (ostia) of the renal arteries, injection of dye, flush aortogram,
G0275005004production of permanent images, and radiologic supervision and interpretation
G0275006004(list separately in addition to primary procedure)
G0278001003Iliac and/or femoral artery angiography, non-selective, bilateral or            Iliac art angio,cardiac cath11      A                                                                                                     C                          I4A 2      02003010120080101        N
G0278002004ipsilateral to catheter insertion, performed at the same time as cardiac
G0278003004catheterization and/or coronary angiography, includes positioning or placement
G0278004004of the catheter in the distal aorta or ipsilateral femoral or iliac artery,
G0278005004injection of dye, production of permanent images, and radiologic supervision
G0278006004and interpretation  (list separately in addition to primary procedure)
G0281001003Electrical stimulation, (unattended), to one or more areas, for chronic stage   Elec stim unattend for press11      A                                                                                                     C                          P5E 1UW    02003040120030401        N
G0281002004iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous
G0281003004statsis ulcers not demonstrating measurable signs of healing after 30 days of
G0281004004conventional care, as part of a therapy plan of care
G0282001003Electrical stimulation, (unattended), to one or more areas, for wound care      Elect stim wound care not pd00      9                  35-98                                                                              M                          P5E 1UW    02003040120030401        N
G0282002004other than described in g0281
G0283001003Electrical stimulation (unattended), to one or more areas for indication(s)     Elec stim other than wound  11      A                                                                                                     C                          P5E 1UW    02003010120030101        N
G0283002004other than wound care, as part of a therapy plan of care
G0288001003Reconstruction, computed tomographic angiography of aorta for surgical planning Recon, CTA for surg plan    11      A                                                                                                     C                          I2B 4      02003010120060101        N
G0288002004for vascular surgery
G0289001003Arthroscopy, knee, surgical, for removal of loose body, foreign body,           Arthro, loose body + chondro11      A                                                                                                     C                          P8A 2      02003010120030101        N
G0289002004debridement/shaving of articular cartilage (chrondroplasty) at the time of
G0289003004other surgical knee arthroscopy in a different compartment of the same knee
G0290001003Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, Drug-eluting stents, single 00      9                                                                            C9600C9601C9602C9603C9604D                      0107P2D 2      0200301012013010120121231D
G0290002004with or without other therapeutic intervention, any method; single vessel
G0291001003Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, Drug-eluting stents,each add00      9                                                                            C9605C9606C9607C9608     D                      0107P2D 2      0200301012013010120121231D
G0291002004with or without other therapeutic intervention, any method; each additional
G0291003004vessel
G0293001003Noncovered surgical procedure(s) using conscious sedation, regional, general or Non-cov surg proc,clin trial00      9                                                                                                     D                      0107Y2  2      02003010120030101        N
G0293002004spinal anesthesia in a medicare qualifying clinical trial, per day
G0294001003Noncovered procedure(s) using either no anesthesia or local anesthesia only, in Non-cov proc, clinical trial00      9                                                                                                     D                      0109Y2  2      02003010120030101        N
G0294002004a medicare qualifying clinical trial, per day
G0295001003Electromagnetic therapy, to one or more areas, for wound care other than        Electromagnetic therapy onc 00      935-98                                                                                                M                          I2B 1UW    02003040120040701        N
G0295002004described in g0329 or for other uses
G0302001003Pre-operative pulmonary surgery services for preparation for lvrs, complete     Pre-op service LVRS complete00      9                                                                                                     C                          T2D 1      02004010120040101        N
G0302002004course of services, to include a minimum of 16 days of services
G0303001003Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15     Pre-op service LVRS 10-15dos00      9                                                                                                     C                          T2D 1      02004010120040101        N
G0303002004days of services
G0304001003Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days  Pre-op service LVRS 1-9 dos 00      9                                                                                                     C                          T2D 1      02004010120040101        N
G0304002004of services
G0305001003Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of      Post op service LVRS min 6  00      9                                                                                                     C                          T2D 1      02004010120040101        N
G0305002004services
G0306001003Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and        CBC/diffwbc w/o platelet    21      A                                                    400                                              C                          T1D 5      02004010120090101        N
G0306002004automated wbc differential count
G0307001003Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)          CBC without platelet        21      A                                                    400                                              C                          T1D 5      02004010120090101        N
G0328001003Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3          Fecal blood scrn immunoassay21      A                                                    310400                                           D                      0064T1H 1      02004010120040101        N
G0328002004simultaneous
G0329001003Electromagnetic therapy, to one or more areas for chronic stage iii and stage   Electromagntic tx for ulcers00      9                                                                                                     C                          I2B 1UW    02004070120040701        N
G0329002004iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers
G0329003004not demonstrating measurable signs of healing after 30 days of conventional
G0329004004care as part of a therapy plan of care
G0333001003Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a      Dispense fee initial 30 day 46      A                                                                                                     D                      0121D1E 9      02006010120060101        N
G0333002004beneficiary
G0337001003Hospice evaluation and counseling services, pre-election                        Hospice evaluation preelecti11      A                                                                                                     C                          M5D 1      02005010120050101        N
G0339001003Image-guided robotic linear accelerator-based stereotactic radiosurgery,        Robot lin-radsurg com, first13      A                                                                                                     CYY20080101                P5E 1      02004010120110101        N
G0339002004complete course of therapy in one session or first session of fractionated
G0339003004treatment
G0340001003Image-guided robotic linear accelerator-based stereotactic radiosurgery,        Robt lin-radsurg fractx 2-5 13      A                                                                                                     CYY20080101                P5E 1      02004010120110101        N
G0340002004delivery including collimator changes and custom plugging, fractionated
G0340003004treatment, all lesions, per session, second through fifth sessions, maximum
G0340004004five sessions per course of treatment
G0341001003Percutaneous islet cell transplant, includes portal vein catheterization and    Percutaneous islet celltrans13      A260.3 35-82                                                                                          D                          P1G 2      02004100120041001        N
G0341002004infusion
G0342001003Laparoscopy for islet cell transplant, includes portal vein catheterization and Laparoscopy islet cell trans13      A35-82                                                                                                D                          P1G 2      02004100120041001        N
G0342002004infusion
G0343001003Laparotomy for islet cell transplant, includes portal vein catheterization and  Laparotomy islet cell transp13      A35-82                                                                                                D                          P1G 2      02004100120041001        N
G0343002004infusion
G0364001003Bone marrow aspiration performed with bone marrow biopsy through the same       Bone marrow aspirate &biopsy11      A                                                                                                     CYY20080101                P6C 2      02005010120050101        N
G0364002004incision on the same date of service
G0365001003Vessel mapping of vessels for hemodialysis access (services for preoperative    Vessel mapping hemo access  11      A                                                                                                     CYY20120101                P9A 5      02005010120050101        N
G0365002004vessel mapping prior to creation of hemodialysis access using an autogenous
G0365003004hemodialysis conduit, including arterial inflow and venous outflow)
G0372001003Physician service required to establish and document the need for a power       MD service required for PMD 13      A                                                                                                     D                      0128M5D 1      02005102520051025        N
G0372002004mobility device
G0378001003Hospital observation service, per hour                                          Hospital observation per hr 00      9                                                                                                     D                      0107M2A 1      02006010120060101        N
G0379001003Direct admission of patient for hospital observation care                       Direct refer hospital observ00      9                                                                                                     D                      0107M2A 1      02006010120100101        N
G0380001003Level 1 hospital emergency department visit provided in a type b emergency      Lev 1 hosp type B ED visit  00      9                                                                                                     C                          M3  1      02007010120080101        N
G0380002004department; (the ed must meet at least one of the following requirements: (1)
G0380003004it is licensed by the state in which it is located under applicable state law
G0380004004as an emergency room or emergency department; (2) it is held out to the public
G0380005004(by name, posted signs, advertising, or other means) as a place that provides
G0380006004care for emergency medical conditions on an urgent basis without requiring a
G0380007004previously scheduled appointment; or (3) during the calendar year immediately
G0380008004preceding the calendar year in which a determination under 42 cfr 489. 24 is
G0380009004being made, based on a representative sample of patient visits that occurred
G0380010004during that calendar year, it provides at least one-third of all of its
G0380011004outpatient visits for the treatment of emergency medical conditions on an
G0380012004urgent basis without requiring a previously scheduled appointment)
G0381001003Level 2 hospital emergency department visit provided in a type b emergency      Lev 2 hosp type B ED visit  00      9                                                                                                     C                          M3  1      02007010120080101        N
G0381002004department; (the ed must meet at least one of the following requirements: (1)
G0381003004it is licensed by the state in which it is located under applicable state law
G0381004004as an emergency room or emergency department; (2) it is held out to the public
G0381005004(by name, posted signs, advertising, or other means) as a place that provides
G0381006004care for emergency medical conditions on an urgent basis without requiring a
G0381007004previously scheduled appointment; or (3) during the calendar year immediately
G0381008004preceding the calendar year in which a determination under 42 cfr 489. 24 is
G0381009004being made, based on a representative sample of patient visits that occurred
G0381010004during that calendar year, it provides at least one-third of all of its
G0381011004outpatient visits for the treatment of emergency medical conditions on an
G0381012004urgent basis without requiring a previously scheduled appointment)
G0382001003Level 3 hospital emergency department visit provided in a type b emergency      Lev 3 hosp type B ED visit  00      9                                                                                                     C                          M3  1      02007010120080101        N
G0382002004department; (the ed must meet at least one of the following requirements: (1)
G0382003004it is licensed by the state in which it is located under applicable state law
G0382004004as an emergency room or emergency department; (2) it is held out to the public
G0382005004(by name, posted signs, advertising, or other means) as a place that provides
G0382006004care for emergency medical conditions on an urgent basis without requiring a
G0382007004previously scheduled appointment; or (3) during the calendar year immediately
G0382008004preceding the calendar year in which a determination under 42 cfr 489. 24 is
G0382009004being made, based on a representative sample of patient visits that occurred
G0382010004during that calendar year, it provides at least one-third of all of its
G0382011004outpatient visits for the treatment of emergency medical conditions on an
G0382012004urgent basis without requiring a previously scheduled appointment)
G0383001003Level 4 hospital emergency department visit provided in a type b emergency      Lev 4 hosp type B ED visit  00      9                                                                                                     C                          M3  1      02007010120080101        N
G0383002004department; (the ed must meet at least one of the following requirements: (1)
G0383003004it is licensed by the state in which it is located under applicable state law
G0383004004as an emergency room or emergency department; (2) it is held out to the public
G0383005004(by name, posted signs, advertising, or other means) as a place that provides
G0383006004care for emergency medical conditions on an urgent basis without requiring a
G0383007004previously scheduled appointment; or (3) during the calendar year immediately
G0383008004preceding the calendar year in which a determination under 42 cfr 489. 24 is
G0383009004being made, based on a representative sample of patient visits that occurred
G0383010004during that calendar year, it provides at least one-third of all of its
G0383011004outpatient visits for the treatment of emergency medical conditions on an
G0383012004urgent basis without requiring a previously scheduled appointment)
G0384001003Level 5 hospital emergency department visit provided in a type b emergency      Lev 5 hosp type B ED visit  00      9                                                                                                     C                          M3  1      02007010120080101        N
G0384002004department; (the ed must meet at least one of the following requirements: (1)
G0384003004it is licensed by the state in which it is located under applicable state law
G0384004004as an emergency room or emergency department; (2) it is held out to the public
G0384005004(by name, posted signs, advertising, or other means) as a place that provides
G0384006004care for emergency medical conditions on an urgent basis without requiring a
G0384007004previously scheduled appointment; or (3) during the calendar year immediately
G0384008004preceding the calendar year in which a determination under 42 cfr 489. 24 is
G0384009004being made, based on a representative sample of patient visits that occurred
G0384010004during that calendar year, it provides at least one-third of all of its
G0384011004outpatient visits for the treatment of emergency medical conditions on an
G0384012004urgent basis without requiring a previously scheduled appointment)
G0389001003Ultrasound b-scan and/or real time with image documentation; for abdominal      Ultrasound exam AAA screen  13      A                                                                                                     D                      0134I3B 4      02007010120070101        N
G0389002004aortic aneurysm (aaa) screening
G0390001003Trauma response team associated with hospital critical care service             Trauma Respons w/hosp criti 00      9                                                                                                     D                      0136M5D 1      02007010120070101        N
G0392001003Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis AV fistula or graft arterial13      A                                                                                                     C                          P1G 2      0200701012010010120091231N
G0392002004access, arteriovenous fistula or graft; arterial
G0393001003Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis AV fistula or graft venous  13      A                                                                                                     C                          P1G 2      0200701012010010120091231N
G0393002004access, arteriovenous fistula or graft; venous
G0396001003Alcohol and/or substance (other than tobacco) abuse structured assessment (e.   Alcohol/subs interv 15-30mn 11      A                                                                                                     C                          M5D 1      02008010120080101        N
G0396002004G. , audit, dast), and brief intervention 15 to 30 minutes
G0397001003Alcohol and/or substance (other than tobacco) abuse structured assessment (e.   Alcohol/subs interv >30 min 11      A                                                                                                     C                          M5D 1      02008010120080101        N
G0397002004G. , audit, dast), and intervention, greater than 30 minutes
G0398001003Home sleep study test (hst) with type ii portable monitor, unattended; minimum  Home sleep test/type 2 Porta13      A                                                                                                     C                          T2D 5      02008031320080313        N
G0398002004of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and
G0398003004oxygen saturation
G0399001003Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4  Home sleep test/type 3 Porta13      A                                                                                                     C                          T2D 5      02008031320080313        N
G0399002004channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen
G0399003004saturation
G0400001003Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3   Home sleep test/type 4 Porta13      A                                                                                                     C                          T2D 5      02008031320080313        N
G0400002004channels
G0402001003Initial preventive physical examination; face-to-face visit, services limited   Initial preventive exam     11      A                                                                                                     C                      0153M1A 1      02009010120090101        N
G0402002004to new beneficiary during the first 12 months of medicare enrollment
G0403001003Electrocardiogram, routine ecg with 12 leads; performed as a screening for the  EKG for initial prevent exam11      A                                                                                                     C                      0153T2C 5      02009010120090101        N
G0403002004initial preventive physical examination with interpretation and report
G0404001003Electrocardiogram, routine ecg with 12 leads; tracing only, without             EKG tracing for initial prev11      A                                                                                                     C                      0153T2C 5      02009010120090101        N
G0404002004interpretation and report, performed as a screening for the initial preventive
G0404003004physical examination
G0405001003Electrocardiogram, routine ecg with 12 leads; interpretation and report only,   EKG interpret & report preve11      A                                                                                                     C                      0153T2C 5      02009010120090101        N
G0405002004performed as a screening for the initial preventive physical examination
G0406001003Follow-up inpatient consultation, limited, physicians typically spend 15        Inpt/tele follow up 15      13      A                                                                                                     C                          M6  3      02009010120120101        N
G0406002004minutes communicating with the patient via telehealth
G0407001003Follow-up inpatient consultation, intermediate, physicians typically spend 25   Inpt/tele follow up 25      11      A                                                                                                     C                          M6  3      02009010120120101        N
G0407002004minutes communicating with the patient via telehealth
G0408001003Follow-up inpatient consultation, complex, physicians typically spend 35        Inpt/tele follow up 35      11      A                                                                                                     C                          M6  3      02009010120120101        N
G0408002004minutes communicating with the patient via telehealth
G0409001003Social work and psychological services, directly relating to and/or furthering  CORF related serv 15 mins ea13      A                                                                                                     C                          M5D 1      02009010120090101        N
G0409002004the patient's rehabilitation goals, each 15 minutes, face-to-face; individual
G0409003004(services provided by a corf-qualified social worker or psychologist in a corf)
G0410001003Group psychotherapy other than of a multiple-family group, in a partial         Grp psych partial hosp 45-5013      A                                                                                                     C                          P6D 1      02009010120090101        N
G0410002004hospitalization setting, approximately 45 to 50 minutes
G0411001003Interactive group psychotherapy, in a partial hospitalization setting,          Inter active grp psych parti13      A                                                                                                     C                          P6D 1      02009010120090101        N
G0411002004approximately 45 to 50 minutes
G0412001003Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing            Open tx iliac spine uni/bil 13      A                                                                                                     C                      0155P3D 2      02009010120090101        N
G0412002004fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do
G0412003004not disrupt the pelvic ring includes internal fixation, when performed
G0413001003Percutaneous skeletal fixation of posterior pelvic bone fracture and/or         Pelvic ring fracture uni/bil13      A                                                                                                     C                      0155P3D 2      02009010120090101        N
G0413002004dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or
G0413003004bilateral, (includes ilium, sacroiliac joint and/or sacrum)
G0414001003Open treatment of anterior pelvic bone fracture and/or dislocation for fracture Pelvic ring fx treat int fix13      A                                                                                                     C                      0155P3D 2      02009010120090101        N
G0414002004patterns which disrupt the pelvic ring, unilateral or bilateral, includes
G0414003004internal fixation when performed (includes pubic symphysis and/or
G0414004004superior/inferior rami)
G0415001003Open treatment of posterior pelvic bone fracture and/or dislocation, for        Open tx post pelvic fxcture 13      A                                                                                                     C                      0155P3D 2      02009010120090101        N
G0415002004fracture patterns which disrupt the pelvic ring, unilateral or bilateral,
G0415003004includes internal fixation, when performed (includes ilium, sacroiliac joint
G0415004004and/or sacrum)
G0416001003Surgical pathology, gross and microscopic examinations for prostate needle      Sat biopsy 10-20            13      A                                                    610                                              C                          T1G 5      02009010120130101        C
G0416002004saturation biopsy sampling, 10-20 specimens
G0417001003Surgical pathology, gross and microscopic examination for prostate needle       Sat biopsy prostate 21-40   13      A                                                    610                                              C                          T1G 5      02009010120100101        N
G0417002004saturation biopsy sampling, 21-40 specimens
G0418001003Surgical pathology, gross and microscopic examination for prostate needle       Sat biopsy prostate 41-60   13      A                                                    610                                              C                          T1G 5      02009010120100101        N
G0418002004saturation biopsy sampling, 41-60 specimens
G0419001003Surgical pathology, gross and microscopic examination for prostate needle       Sat biopsy prostate: >60    13      A                                                    610                                              C                          T1G 5      02009010120100101        N
G0419002004saturation biopsy sampling, greater than 60 specimens
G0420001003Face-to-face educational services related to the care of chronic kidney         Ed svc CKD ind per session  11      A                                                                                                     C                          M1B 1      02010010120100101        N
G0420002004disease; individual, per session, per one hour
G0421001003Face-to-face educational services related to the care of chronic kidney         Ed svc CKD grp per session  11      A                                                                                                     C                          M1B 1      02010010120100101        N
G0421002004disease; group, per session, per one hour
G0422001003Intensive cardiac rehabilitation; with or without continuous ecg monitoring     Intens cardiac rehab w/exerc11      A                                                                                                     C                          M5D 1      02010010120100101        N
G0422002004with exercise, per session
G0423001003Intensive cardiac rehabilitation; with or without continuous ecg monitoring;    Intens cardiac rehab no exer11      A                                                                                                     C                          M5D 1      02010010120100101        N
G0423002004without exercise, per session
G0424001003Pulmonary rehabilitation, including exercise (includes monitoring), one hour,   Pulmonary rehab w exer      11      A                                                                                                     C                          M5D 1      02010010120100101        N
G0424002004per session, up to two sessions per day
G0425001003Telehealth consultation, emergency department or initial inpatient, typically   Inpt/ED teleconsult30       13      A                                                                                                     C                          M6  3      02010010120120101        N
G042500200430 minutes communicating with the patient via telehealth
G0426001003Telehealth consultation, emergency department or initial inpatient, typically   Inpt/ED teleconsult50       13      A                                                                                                     C                          M6  3      02010010120120101        N
G042600200450 minutes communicating with the patient via telehealth
G0427001003Telehealth consultation, emergency department or initial inpatient, typically   Inpt/ED teleconsult70       13      A                                                                                                     C                          M6  3      02010010120120101        N
G042700200470 minutes or more communicating with the patient via telehealth
G0428001003Collagen meniscus implant procedure for filling meniscal defects (e. G. , cmi,  Collagen Meniscus Implant   00      9                                                                                                     M                      0169P1G 2      02010052520100525        N
G0428002004collagen scaffold, menaflex)
G0429001003Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome   Dermal filler injection(s)  13      A                                                                                                     C                          P6A 1      02010032320100323        N
G0429002004(lds) (e. G. , as a result of highly active antiretroviral therapy)
G0430001003Drug screen, qualitative; multiple drug classes other than chromatographic      Drug screen multi class     13      A                                                    340                     G0434                    C                          T1H 5      0201001012011010120101231N
G0430002004method,  each procedure
G0431001003Drug screen, qualitative; multiple drug classes by high complexity test method  Drug screen multiple class  13      A                                                    340                                              C                          T1H 5      02010010120110101        N
G0431002004(e. G. , immunoassay, enzyme assay), per patient encounter
G0432001003Infectious agent antibody detection by enzyme immunoassay (eia) technique,      EIA HIV-1/HIV-2 screen      21      A                                                    140220                                           C                      0164T1H 9      02009120820101001        N
G0432002004hiv-1 and/or hiv-2, screening
G0433001003Infectious agent antibody detection by enzyme-linked immunosorbent assay        ELISA HIV-1/HIV-2 screen    21      A                                                    140220                                           C                      0164T1H 9      02009120820130101        F
G0433002004(elisa) technique, hiv-1 and/or hiv-2, screening
G0434001003Drug screen, other than chromatographic; any number of drug classes, by clia    Drug screen multi drug class21      A                                                    340                                              C                          T1H 5      02011010120130101        F
G0434002004waived test or moderate complexity test, per patient encounter
G0435001003Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, Oral HIV-1/HIV-2 screen     21      A                                                    140220                                           C                      0164T1H 9      02009120820101001        N
G0435002004screening
G0436001003Smoking and tobacco cessation counseling visit for the asymptomatic patient;    Tobacco-use counsel 3-10 min13      A                                                                                                     C                          P5E 1      02011010120110101        N
G0436002004intermediate, greater than 3 minutes, up to 10 minutes
G0437001003Smoking and tobacco cessation counseling visit for the asymptomatic patient;    Tobacco-use counsel>10min   13      A                                                                                                     C                          P5E 1      02011010120110101        N
G0437002004intensive, greater than 10 minutes
G0438001003Annual wellness visit; includes a personalized prevention plan of service       PPPS, initial visit         13      A                                                                                                     C                          M5D 1      02011010120110101        N
G0438002004(pps), initial visit
G0439001003Annual wellness visit, includes a personalized prevention plan of service       PPPS, subseq visit          13      A                                                                                                     C                          M5D 1      02011010120110101        N
G0439002004(pps), subsequent visit
G0440001003Application of tissue cultured allogeneic skin substitute or dermal substitute; Skin/dermal subs init 25or< 13      A                                                                                                     C                          P6C 1      0201101012012010120111231N
G0440002004for use on lower limb, includes the site preparation and debridement if
G0440003004performed; first 25 sq cm or less
G0441001003Application of tissue cultured allogeneic skin substitute or dermal substitute; Skin/dermal subs each additi13      A                                                                                                     C                          P6C 1      0201101012012010120111231N
G0441002004for use on lower limb, includes the site preparation and debridement if
G0441003004performed; each additional 25 sq cm
G0442001003Annual alcohol misuse screening, 15 minutes                                     Annual alcohol screen 15 min13      A                                                                                                     C                          Y1  1      02011101420111014        N
G0443001003Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes         Brief alcohol misuse counsel13      A                                                                                                     C                          Y1  1      02011101420111014        N
G0444001003Annual depression screening, 15 minutes                                         Depression screen annual    13      A                                                                                                     C                          Y1  1      02011101420111014        N
G0445001003High intensity behavioral counseling to prevent sexually transmitted infection; High inten beh couns STD 30m13      A                                                                                                     C                          Y1  1      02011110820111108        N
G0445002004face-to-face, individual, includes: education, skills training and guidance on
G0445003004how to change sexual behavior; performed semi-annually, 30 minutes
G0446001003Annual, face-to-face intensive behavioral therapy for cardiovascular disease,   Intens behave ther cardio dx13      A                                                                                                     C                          Y1  1      02011110820111108        N
G0446002004individual, 15 minutes
G0447001003Face-to-face behavioral counseling for obesity, 15 minutes                      Behavior counsel obesity 15m13      A                                                                                                     C                          Y1  1      02011112920111129        N
G0448001003Insertion or replacement of a permanent pacing cardioverter-defibrillator       Place perm pacing cardiovert13      A                                                                                                     CYY20120101                Y1  2      02012010120120101        N
G0448002004system with transvenous lead(s), single or dual chamber with insertion of
G0448003004pacing electrode, cardiac venous system, for left ventricular pacing
G0451001003Development testing, with interpretation and report, per standardized           Devlopment test interpt&rep 13      A                                                                                                     C                          M5D 1      02012010120120101        N
G0451002004instrument form
G0452001003Molecular pathology procedure; physician interpretation and report              Molecular pathology interpr 13      A                                                                                                     C                          T2D 1      02013010120130101        A
G0453001003Continuous intraoperative neurophysiology monitoring, from outside the          Cont intraop neuro monitor  13      A                                                                                                     C                          T2D 1      02013010120130101        A
G0453002004operating room (remote or nearby), per patient, (attention directed exclusively
G0453003004to one patient) each 15 minutes (list in addition to primary procedure)
G0454001003Physician documentation of face-to-face visit for durable medical equipment     MD document visit by NPP    13      A                                                                                                     C                          M5D 1      02013010120130101        A
G0454002004determination performed by nurse practitioner, physician assistant or clinical
G0454003004nurse specialist
G0455001003Preparation with instillation of fecal microbiota by any method, including      Fecal microbiota prep instil13      A                                                                                                     C                          T2D 1      02013010120130101        A
G0455002004assessment of donor specimen
G0456001003Negative pressure wound therapy, (e. G. Vacuum assisted drainage collection)    Neg pre wound <=50 sq cm    13      A                                                                                                     C                          P6A 1      02013010120130101        A
G0456002004using a mechanically-powered device, not durable medical equipment, including
G0456003004provision of cartridge and dressing(s), topical application(s), wound
G0456004004assessment, and instructions for ongoing care, per session; total wounds(s)
G0456005004surface area less than or equal to 50 square centimeters
G0457001003Negative pressure wound therapy, (e. G. Vacuum assisted drainage collection)    Neg pres wound >50 sq cm    13      A                                                                                                     C                          P6A 1      02013010120130101        A
G0457002004using a mechanically-powered device, not durable medical equipment, including
G0457003004provision of cartridge and dressing(s), topical application(s), wound
G0457004004assessment, and instructions for ongoing care, per session; total wounds(s)
G0457005004surface area greater than 50 square centimeters
G0458001003Low dose rate (ldr) prostate brachytherapy services, composite rate             LDR prostate brachy comp rat00      9                                                                                                     CYY20130101            0185P7A 6      02013010120130101        A
G0908001003Most recent hemoglobin (hgb) level > 12. 0 g/dl                                 HgB > 12 g/dL               00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0909001003Hemoglobin level measurement not documented, reason not given                   HbG not doc                 00      9                                                                                                     C                          M5D 1      02012010120130101        C
G0910001003Most recent hemoglobin level <= 12. 0 g/dl                                      HgB <= 12 g/dL              00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0911001003Assessed level of activity and symptoms                                         Assess activity symptoms    00      9                                                                                                     C                          M5D 1      0201201012013010120121231D
G0912001003Level of activity and symptoms not assessed                                     No assess activity symptoms 00      9                                                                                                     C                          M5D 1      0201201012013010120121231D
G0913001003Improvement in visual function achieved within 90 days following cataract       Improve visual funct        00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0913002004surgery
G0914001003Patient care survey was not completed by patient                                Survey not complete         00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0915001003Improvement in visual function not achieved within 90 days following cataract   No improve visual funct     00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0915002004surgery
G0916001003Satisfaction with care achieved within 90 days following cataract surgery       Satisfy with care           00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0917001003Patient satisfaction survey was not completed by patient                        Satisfy survey not complete 00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0918001003Satisfaction with care not achieved within 90 days following cataract surgery   No satisfy with care        00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0919001003Influenza immunization ordered or recommended (to be given at alternate         Flu immunize not avail      00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0919002004location or alternate provider); vaccine not available at time of visit
G0920001003Type, anatomic location, and activity all documented                            Type loc act doc            00      9                                                                                                     C                          M5D 1      02012010120120101        N
G0921001003Documentation of patient reason(s) for not being able to assess (e. G. ,        Doc pt reas no assess       00      9                                                                                                     C                          M5D 1      02012010120130101        C
G0921002004patient refuses endoscopic and/or radiologic assessment)
G0922001003No documentation of disease type, anatomic location, and activity, reason not   Type loc act not doc        00      9                                                                                                     C                          M5D 1      02012010120130101        C
G0922002004given
G3001001003Administration and supply of tositumomab, 450 mg                                Admin + supply, tositumomab 13      A                                                                                                     C                          T2D 1      02003070120030701        N
G8006001003Acute myocardial infarction: patient documented to have received aspirin at     AMI pt recd aspirin at arriv00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8006002004arrival
G8007001003Acute myocardial infarction: patient not documented to have received aspirin at AMI pt did not receiv aspiri00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8007002004arrival
G8008001003Clinician documented that acute myocardial infarction patient was not an        AMI pt ineligible for aspiri00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8008002004eligible candidate to receive aspirin at arrival measure
G8009001003Acute myocardial infarction: patient documented to have received beta-blocker   AMI pt recd Bblock at arr   00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8009002004at arrival
G8010001003Acute myocardial infarction: patient not documented to have received            AMI pt did not rec bblock   00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8010002004beta-blocker at arrival
G8011001003Clinician documented that acute myocardial infarction patient was not an        AMI pt inelig Bbloc at arriv00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8011002004eligible candidate for beta-blocker at arrival measure
G8012001003Pneumonia: patient documented to have received antibiotic within 4 hours of     Pneum pt recv antibiotic 4 h00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8012002004presentation
G8013001003Pneumonia: patient not documented to have received antibiotic within 4 hours of Pneum pt w/o antibiotic 4 hr00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8013002004presentation
G8014001003Clinician documented that pneumonia patient was not an eligible candidate for   Pneum pt not elig antibiotic00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8014002004antibiotic within 4 hours of presentation measure
G8015001003Diabetic patient with most recent hemoglobin a1c level (within the last 6       Diabetic pt w/ HBA1c>9%     00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8015002004months) documented as greater than 9%
G8016001003Diabetic patient with most recent hemoglobin a1c level (within the last 6       Diabetic pt w/ HBA1c<or=9%  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8016002004months) documented as less than or equal to 9%
G8017001003Clinician documented that diabetic patient was not eligible candidate for       DM pt inelig for HBA1c measu00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8017002004hemoglobin a1c measure
G8018001003Clinician has not provided care for the diabetic patient for the required time  Care not provided for HbA1c 00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8018002004for hemoglobin a1c measure (6 months)
G8019001003Diabetic patient with most recent low-density lipoprotein (within the last 12   Diabetic pt w/LDL>= 100mg/dl00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8019002004months) documented as greater than or equal to 100 mg/dl
G8020001003Diabetic patient with most recent low-density lipoprotein (within the last 12   Diab pt w/LDL< 100mg/dl     00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8020002004months) documented as less than 100 mg/dl
G8021001003Clinician documented that diabetic patient was not eligible candidate for       Diab pt inelig for LDL meas 00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8021002004low-density lipoprotein measure
G8022001003Clinician has not provided care for the diabetic patient for the required time  Care not provided for LDL   00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8022002004for low-density lipoprotein measure (12 months)
G8023001003Diabetic patient with most recent blood pressure (within the last 6 months)     DM pt w BP>=140/80          00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8023002004documented as equal to or greater than 140 systolic or equal to or greater than
G802300300480 mmhg diastolic
G8024001003Diabetic patient with most recent blood pressure (within the last 6 months)     Diabetic pt wBP<140/80      00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8024002004documented as less than 140 systolic and less than 80 diastolic
G8025001003Clinician documented that the diabetic patient was not eligible candidate for   Diabetic pt inelig for BP me00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8025002004blood pressure measure
G8026001003Clinician has not provided care for the diabetic patient for the required time  Diabet pt w no care re BP me00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8026002004for blood pressure measure (within the last 6 months)
G8027001003Heart failure patient with left ventricular systolic dysfunction (lvsd)         HF p w/LVSD on ACE-I/ARB    00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8027002004documented to be on either angiotensin-converting enzyme inhibitor or
G8027003004angiotensin-receptor blocker (ace-i or arb) therapy
G8028001003Heart failure patient with left ventricular systolic dysfunction (lvsd) not     HF pt w/LVSD not on ACE-I/AR00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8028002004documented to be on either angiotensin-converting enzyme inhibitor or
G8028003004angiotensin-receptor blocker (ace-i or arb) therapy
G8029001003Clinician documented that heart failure patient was not an eligible candidate   HF pt not elig for ACE-I/ARB00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8029002004for either angiotensin-converting enzyme inhibitor or angiotensin-receptor
G8029003004blocker (ace-i or arb) therapy measure
G8030001003Heart failure patient with left ventricular systolic dysfunction (lvsd)         HF pt w/LVSD on Bblocker    00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8030002004documented to be on beta-blocker therapy
G8031001003Heart failure patient with left ventricular systolic dysfunction (lvsd) not     HF pt w/LVSD not on Bblocker00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8031002004documented to be on beta-blocker therapy
G8032001003Clinician documented that heart failure patient was not eligible candidate for  HF pt not elig for Bblocker 00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8032002004beta-blocker therapy measure
G8033001003Prior myocardial infarction - coronary artery disease patient documented to be  PMI-CAD pt on Bblocker      00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8033002004on beta-blocker therapy
G8034001003Prior myocardial infarction - coronary artery disease patient not documented to PMI-CAD pt not on Bblocker  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8034002004be on beta-blocker therapy
G8035001003Clinician documented that prior myocardial infarction - coronary artery disease PMI-CAD pt inelig Bblocker  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8035002004patient was not eligible candidate for beta-blocker therapy measure
G8036001003Coronary artery disease patient documented to be on antiplatelet therapy        AMI-CAD pt doc on antiplatel00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8037001003Coronary artery disease patient not documented to be on antiplatelet therapy    AMI-CAD pt not docu on antip00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8038001003Clinician documented that coronary artery disease patient was not eligible      AMI-CAD inelig antiplate mea00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8038002004candidate for antiplatelet therapy measure
G8039001003Coronary artery disease - patient with low-density lipoprotein documented to be CAD pt w/LDL>100mg/dl       00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8039002004greater than 100mg/dl
G8040001003Coronary artery disease - patient with low-density lipoprotein documented to be CAD pt w/LDL<or=100mg/dl    00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8040002004less than or equal to 100mg/dl
G8041001003Clinician documented that coronary artery disease patient was not eligible      CAD pt not eligible for LDL 00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8041002004candidate for low-density lipoprotein measure
G8051001003Patient (female) documented to have been assessed for osteoporosis              Osteoporosis assess         00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8052001003Patient (female) not documented to have been assessed for osteoporosis          Osteopor pt not assess      00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8053001003Clinician documented that (female) patient was not an eligible candidate for    Pt inelig for osteopor meas 00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8053002004osteoporosis assessment measure
G8054001003Patient not documented for the assessment for falls within last 12 months       Falls assess not docum 12 mo00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8055001003Patient documented for the assessment for falls within last 12 months           Falls assess w/ 12 mon      00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8056001003Clinician documented that patient was not an eligible candidate for the falls   Not elig for falls assessmen00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8056002004assessment measure within the last 12 months
G8057001003Patient documented to have received hearing assessment                          Hearing assess receive      00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8058001003Patient not documented to have received hearing assessment                      Pt w/o hearing assess       00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8059001003Clinician documented that patient was not an eligible candidate for hearing     Pt inelig for hearing assess00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8059002004assessment measure
G8060001003Patient documented for the assessment of urinary incontinence                   Urinary incont pt assess    00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8061001003Patient not documented for the assessment of urinary incontinence               Pt not assess for urinary in00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8062001003Clinician documented that patient was not an eligible candidate for urinary     Pt not elig for urinary inco00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8062002004incontinence assessment measure
G8075001003End stage renal disease patient with documented dialysis dose of urr greater    ESRD pt w/ dialy of URR>=65%00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8075002004than or equal to 65% (or kt/v greater than or equal to 1. 2)
G8076001003End stage renal disease patient with documented dialysis dose of urr less than  ESRD pt w/ dialy of URR<65% 00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G807600200465% (or kt/v less than 1. 2)
G8077001003Clinician documented that end stage renal disease patient was not an eligible   ESRD pt not elig for URR/KtV00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8077002004candidate for urr or kt/v measure
G8078001003End stage renal disease patient with documented hematocrit greater than or      ESRD pt w/Hct>or=33         00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8078002004equal to 33 (or hemoglobin greater than or equal to 11)
G8079001003End stage renal disease patient with documented hematocrit less than 33 (or     ESRD pt w/Hct<33            00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8079002004hemoglobin less than 11)
G8080001003Clinician documented that end stage renal disease patient was not an eligible   ESRD pt inelig for HCT/Hgb  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8080002004candidate for hematocrit (hemoglobin) measure
G8081001003End stage renal disease patient requiring hemodialysis vascular access          ESRD pt w/ auto AV fistula  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8081002004documented to have received autogenous av fistula
G8082001003End stage renal disease patient requiring hemodialysis documented to have       ESRD pt w other fistula     00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8082002004received vascular access other than autogenous av fistula
G8085001003End-stage renal disease patient requiring hemodialysis vascular access was not  ESRD PT inelig auto AV FISTU00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8085002004an eligible candidate for autogenous av fistula
G8093001003Newly diagnosed chronic obstructive pulmonary disease (copd) patient documented COPD pt rec smoking cessat  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8093002004to have received smoking cessation intervention, within 3 months of diagnosis
G8094001003Newly diagnosed chronic obstructive pulmonary disease (copd) patient not        COPD pt w/o smoke cessat int00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8094002004documented to have received smoking cessation intervention, within 3 months of
G8094003004diagnosis
G8099001003Osteoporosis patient documented to have been prescribed calcium and vitamin d   Osteopo pt given Ca+VitD sup00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8099002004supplements
G8100001003Clinician documented that osteoporosis patient was not an eligible candidate    Osteop pt inelig for Ca+VitD00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8100002004for calcium and vitamin d supplement measure
G8103001003Newly diagnosed osteoporosis patients documented to have been treated with      New dx osteo pt w/antiresorp00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8103002004antiresorptive therapy and/or pth within 3 months of diagnosis
G8104001003Clinician documented that newly diagnosed osteoporosis patient was not an       Osteo pt inelig for antireso00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8104002004eligible candidate for antiresorptive therapy and/or pth treatment measure
G8104003004within 3 months of diagnosis
G8106001003Within 6 months of suffering a nontraumatic fracture, female patient 65 years   Bone dens meas test perf    00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8106002004of age or older documented to have undergone bone mineral density testing or to
G8106003004have been prescribed a drug to treat or prevent osteoporosis
G8107001003Clinician documented that female patient 65 years of age or older who suffered  Bone dens meas test inelig  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8107002004a nontraumatic fracture within the last 6 months was not an eligible candidate
G8107003004for measure to test bone mineral density or drug to treat or prevent
G8107004004osteoporosis
G8108001003Patient documented to have received influenza vaccination during influenza      Pt receiv influenza vacc    00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8108002004season
G8109001003Patient not documented to have received influenza vaccination during influenza  Pt w/o influenza vacc       00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8109002004season
G8110001003Clinician documented that patient was not an eligible candidate for influenza   Pt inelig for influenza vacc00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8110002004vaccination measure
G8111001003Patient (female) documented to have received a mammogram during the measurement Pt receiv mammogram         00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8111002004year or prior year to the measurement year
G8112001003Patient (female) not documented to have received a mammogram during the         Pt not doc mammogram        00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8112002004measurement year or prior year to the measurement year
G8113001003Clinician documented that female patient was not an eligible candidate for      Pt ineligible mammography   00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8113002004mammography measure
G8114001003Clinician did not provide care to patient for the required time of mammography  Care not provided for mamogr00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8114002004measure (i. E. , measurement year or prior year)
G8115001003Patient documented to have received pneumococcal vaccination                    Pt receiv pneumo vacc       00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8116001003Patient not documented to have received pneumococcal vaccination                Pt did not rec pneumo vacc  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8117001003Clinician documented that patient was not an eligible candidate for             Pt was inelig for pneumo vac00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8117002004pneumococcal vaccination measure
G8126001003Patient documented as being treated with antidepressant medication during the   Pt treat w/antidepress12wks 00      9                                                                                                     C                          M5D 1      02006010120060101        N
G8126002004entire 12 week acute treatment phase
G8127001003Patient not documented as being treated with antidepressant medication during   Pt not treat w/antidepres12w00      9                                                                                                     C                          M5D 1      02006010120060101        N
G8127002004the entire 12 weeks acute treatment phase
G8128001003Clinician documented that patient was not an eligible candidate for             Pt inelig for antidepres med00      9                                                                                                     C                          M5D 1      02006010120060101        N
G8128002004antidepressant medication during the entire 12 week acute treatment phase
G8128003004measure
G8129001003Patient documented as being treated with antidepressant medication for at least Pt treat w/antidepres for 6m00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G81290020046 months continuous treatment phase
G8130001003Patient not documented as being treated with antidepressant medication for at   Pt not treat w/antidepres 6m00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8130002004least 6 months continuous treatment phase
G8131001003Clinician documented that patient was not an eligible candidate for             Pt inelig for antidepres med00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8131002004antidepressant medication for continuous treatment phase
G8152001003Patient documented to have received antibiotic prophylaxis one hour prior to    Pt w/AB 1 hr prior to incisi00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8152002004incision time (two hours for vancomycin)
G8153001003Patient not documented to have received antibiotic prophylaxis one hour prior   Pt not doc for AB 1 hr prior00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8153002004to incision time (two hours for vancomycin)
G8154001003Clinician documented that patient was not an eligible candidate for antibiotic  Pt ineligi for AB therapy   00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8154002004prophylaxis one hour prior to incision time (two hours for vancomycin) measure
G8155001003Patient with documented receipt of thromboembolism prophylaxis                  Pt recd thromboemb prophylax00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8156001003Patient without documented receipt of thromboembolism prophylaxis               Pt did not rec thromboembo  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8157001003Clinician documented that patient was not an eligible candidate for             Pt ineligi for thrombolism  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8157002004thromboembolism prophylaxis measure
G8159001003Patient documented to have received coronary artery bypass graft without use of Pt w/CABG w/o IMA           00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8159002004internal mammary artery
G8162001003Patient with isolated coronary artery bypass graft not documented to have       Iso CABG pt w/o preop Bblock00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8162002004received pre-operative beta-blockade
G8164001003Patient with isolated coronary artery bypass graft documented to have prolonged Iso CABG pt w/prolng intub  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8164002004intubation
G8165001003Patient with isolated coronary artery bypass graft not documented to have       Iso CABG pt w/o prolng intub00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8165002004prolonged intubation
G8166001003Patient with isolated coronary artery bypass graft documented to have required  Iso CABG req surg rexpo     00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8166002004surgical re-exploration
G8167001003Patient with isolated coronary artery bypass graft did not require surgical     Iso CABG w/o surg explo     00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8167002004re-exploration
G8170001003Patient with isolated coronary artery bypass graft documented to have been      CEA/ext bypass pt on aspirin00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8170002004discharged on aspirin or clopidogrel
G8171001003Patient with isolated coronary artery bypass graft not documented to have been  Pt w/carot endarct/ext bypas00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8171002004discharged on aspirin or clopidogrel
G8172001003Clinician documented that patient with isolated coronary artery bypass graft    CEA/ext bypass pt not on asp00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8172002004was not an eligible candidate for antiplatelet therapy at discharge measure
G8182001003Clinician has not provided care for the cardiac patient for the required time   CAD pt care not prov LDL    00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8182002004for low-density lipoprotein measure (6 months)
G8183001003Patient with heart failure and atrial fibrillation documented to be on warfarin HF/atrial fib pt on warfarin00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8183002004therapy
G8184001003Clinician documented that patient with heart failure and atrial fibrillation    HF/atrial fib pt inelig warf00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8184002004was not an eligible candidate for warfarin therapy measure
G8185001003Patients diagnosed with symptomatic osteoarthritis with documented annual       Osteoarth pt w/ assess pain 00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8185002004assessment of function and pain
G8186001003Clinician documented that symptomatic osteoarthritis patient was not an         Osteoarth pt inelig assess  00      9                                                                                                     C                          M5D 1      0200601012011010120101231N
G8186002004eligible candidate for annual assessment of function and pain measure
G8193001003Clinician did not document that an order for prophylactic antibiotic to be      Antibio not doc prior surg  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8193002004given within one hour (if vancomycin, two hours) prior to surgical incision (or
G8193003004start of procedure when no incision is required) was given
G8196001003Clinician did not document a prophylactic antibiotic was administered within    Antibio not docum prior surg00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8196002004one hour (if vancomycin, two hours) prior to surgical incision (or start of
G8196003004procedure when no incision is required)
G8200001003Order for cefazolin or cefuroxime for antimicrobial prophylaxis not documented  Cefazolin not docum prophy  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8204001003Clinician did not document an order was given to discontinue prophylactic       MD not doc order to d/c anti00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8204002004antibiotics within 24 hours of surgical end time
G8209001003Clinician did not document an order was given to discontinue prophylactic       Clinician did not doc       00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8209002004antibiotics within 48 hours of surgical end time
G8214001003Clinician did not document an order was given for appropriate venous            Clini not doc order VTE     00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8214002004thromboembolism (vte) prophylaxis to be given within 24 hrs prior to incision
G8214003004time or 24 hours after surgery end time
G8217001003Patient not documented to have received dvt prophylaxis by end of hospital day 2Pt not received DVT proph   00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8219001003Patient documented to have received dvt prophylaxis by end of hospital day 2    Received DVT proph day 2    00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8220001003Patient not documented to have received dvt prophylaxis by end of hospital day 2Pt not rec DVT proph day 2  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8221001003Clinician documented that patient was not an eligible candidate for dvt         Pt inelig for DVT proph     00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8221002004prophylaxis by the end of hospital day 2, including physician documentation
G8221003004that patient is ambulatory
G8223001003Patient not documented to have received prescription for antiplatelet therapy   Pt not doc for presc antipla00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8223002004at discharge
G8226001003Patient not documented to have received prescription for anticoagulant therapy  Pt no prescr anticoa at D/C 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8226002004at discharge
G8231001003Patient not documented to have received t-pa or not documented to have been     Pt not doc for admin t-PA   00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8231002004considered a candidate for t-pa administration
G8234001003Patient not documented to have received dysphagia screening                     Pt not doc dysphagia screen 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8238001003Patient not documented to have received order for or consideration for          Pt not doc to rec rehab serv00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8238002004rehabilitation services
G8240001003Internal carotid stenosis patient in the 30-99% range, and no documentation of  Inter carotid stenosis30-99%00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8240002004reference to measurements of distal internal carotid diameter as the
G8240003004denominator for stenosis measurement
G8243001003Patient not documented to have received ct or mri and the presence or absence   Pt not doc MRI/CT w/o lesion00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8243002004of hemorrhage, mass lesion and acute infarction not documented in the final
G8243003004report
G8246001003Patient was not an eligible candidate for medical history review with           Pt inelig hx w new/chg mole 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8246002004assessment of new or changing moles
G8248001003Patient with at least one alarm symptom not documented to have had upper        Pt w/one alarm symp not doc 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8248002004endoscopy or referral for upper endoscopy
G8251001003Patient not documented to have received an esophageal biopsy when suspicion of  Pt not doc w/Barretts, endo 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8251002004barrett's esophagus is indicated in the endoscopy report
G8254001003Patient with no documentation order for barium swallow test                     Pt w/no doc order for barium00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8257001003Clinician has not documented reconciliation of discharge medications with       Pt not doc rev meds D/C     00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8257002004current medication list in medical record
G8260001003Patient not documented to have surrogate decision maker or advance care plan in Pt not doc to have dec maker00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8260002004medical record
G8263001003Patient not documented to have been assessed for presence or absence of urinary Pt not doc assess urinary in00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8263002004incontinence
G8266001003Patient not documented to have received characterization of urinary incontinencePt not doc charc urin incon 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8268001003Patient not documented to have received plan of care for urinary incontinence   Pt not doc rec care urin inc00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8271001003Patient with no documentation of screening for fall risks (2 or more falls in   Pt no doc screen fall       00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8271002004the past year or any fall with injury in the past year)
G8274001003Clinician has not documented presence or absence of alarm symptoms              Clini not doc pres/abs alarm00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8276001003Patient not documented to have received medical history with assessment of new  Pt not doc mole change      00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8276002004or changing moles
G8279001003Patient not documented to have received a complete physical skin exam           Pt not doc rec PE           00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8282001003Patient not documented to have received counseling to perform a self-examinationPt not doc to rec couns     00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8285001003Patient not documented to have received pharmacologic therapy                   Pt did not rec pres osteo   00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8289001003Patient with no documentation of calcium and vitamin d use or counseling        Pt not doc rec Ca/Vit D     00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8289002004regarding both calcium and vitamin d use, or exercise
G8293001003Copd patient without spirometry results documented                              COPD pt w/o spir results    00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8296001003Copd patient not documented to have inhaled bronchodilator therapy prescribed   COPD pt not doc bronch ther 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8298001003Patient documented to have received optic nerve head evaluation                 Pt doc optic nerve eval     00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8299001003Patient not documented to have received optic nerve head evaluation             Pt not doc optic nerv eval  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8302001003Patient documented to have a specific target intraocular pressure range goal    Pt doc w/ target IOP        00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8303001003Patient not documented to have a specific target intraocular pressure range goalPt not doc w/ IOP           00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8304001003Clinician documented that patient was not an eligible candidate for a specific  Clin doc pt inelig IOP      00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8304002004target intraocular pressure range goal
G8305001003Clinician has not provided care for the primary open-angle glaucoma patient for Clin not prov care POAG     00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8305002004the required time for treatment range goal documentation measurement
G8306001003Primary open-angle glaucoma patient with intraocular pressure above the target  POAG w/ IOP rec care plan   00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8306002004range goal documented to have received plan of care
G8307001003Primary open-angle glaucoma patient with intraocular pressure at or below goal, POAG w/ IOP no care plan    00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8307002004no plan of care necessary
G8308001003Primary open-angle glaucoma patient with intraocular pressure above the target  POAG w/ IOP not doc plan    00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8308002004range goal, and not documented to have received plan of care during the
G8308003004reporting year
G8310001003Patient not documented to have been prescribed/recommended at least one         Pt not doc rec antiox       00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8310002004antioxidant vitamin or mineral supplement during the reporting year
G8314001003Patient not documented to have received macular exam with documentation of      Pt not doc to rec mac exam  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8314002004presence or absence of macular thickening or hemorrhage and no documentation of
G8314003004level of macular degeneration severity
G8318001003Patient documented not to have visual functional status assessed                Pt doc not have visual func 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8322001003Patient not documented to have had pre-surgical axial length, corneal power     Pt not doc pre axial leng   00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8322002004measurement and method of intraocular lens power calculation
G8326001003Patient not documented to have received fundus evaluation within six months     Pt not doc rec fundus exam  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8326002004prior to cataract surgery
G8330001003Patient not documented to have received dilated macular or fundus exam with     Pt not doc rec dilated mac  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8330002004level of severity of retinopathy and the presence or absence of macular edema
G8330003004not documented
G8334001003Documentation of findings of macular or fundus exam not communicated to the     Doc of macular not giv MD   00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8334002004physician managing the patient's ongoing diabetes care
G8338001003Clinician has not documented that communication was sent to the physician       Clin not doc pt test osteo  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8338002004managing ongoing care of patient that a fracture occurred and that the patient
G8338003004was or should be tested or treated for osteoporosis
G8341001003Patient not documented to have had central dexa measurement or pharmacologic    Pt not doc for DEXA         00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8341002004therapy
G8345001003Patient not documented to have had central dexa measurement ordered or          Pt not doc have DEXA        00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8345002004performed or pharmacologic therapy
G8351001003Patient not documented to have had ecg                                          Pt not doc ECG              00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8354001003Patient not documented to have received or taken aspirin 24 hours before        Pt not rec aspirin prior ER 00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8354002004emergency department arrival or during emergency department stay
G8357001003Patient not documented to have had ecg                                          Pt not doc to have ECG      00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8360001003Patient not documented to have vital signs recorded and reviewed                Pt not doc vital signs recor00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8362001003Patient not documented to have oxygen saturation assessed                       Pt not doc 02 SAT assess    00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8365001003Patient not documented to have mental status assessed                           Pt not doc mental status    00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8367001003Patient not documented to have appropriate empiric antibiotic prescribed        Pt not doc have empiric AB  00      9                                                                                                     C                          M5D 1      0200701012011010120101231N
G8370001003Asthma patients with numeric frequency of symptoms or patient completion of an  Asthma pt w survey not docum00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8370002004asthma assessment tool/survey/questionnaire not documented
G8371001003Chemotherapy documented as not received or prescribed for stage iii colon       Chemother not rec stg3 colon00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8371002004cancer patients
G8372001003Chemotherapy documented as received or prescribed for stage iii colon cancer    Chemother rec stg3 colon ca 00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8372002004patients
G8373001003Chemotherapy plan documented prior to chemotherapy administration               Chemo plan documen prior che00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8374001003Chemotherapy plan not documented prior to chemotherapy administration           Chemo plan not doc prior che00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8375001003Chronic lymphocytic leukemia (cll) patient with no documentation of baseline    CLL pt w/o doc flow cytometr00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8375002004flow cytometry performed
G8376001003Clinician documentation that breast cancer patient was not eligible for         Brst ca pt inelig tamoxifen 00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8376002004tamoxifen or aromatase inhibitor therapy measure
G8377001003Clinician documentation that colon cancer patient is not eligible for           MD doc colon ca pt inelig ch00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8377002004chemotherapy measure
G8378001003Clinician documentation that patient was not an eligible candidate for          MD doc pt inelig radiation  00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8378002004radiation therapy measure
G8379001003Documentation of radiation therapy recommended within 12 months of first office Doc radiat tx recom 12mo ov 00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8379002004visit
G8380001003For patients with er or pr positive, stage ic-iii breast cancer, clinician did  Pt w stgIC-3Brst ca not rec 00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8380002004not document that the patient received or was prescribed tamoxifen or aromatase
G8380003004inhibitor
G8381001003For patients with er or pr positive, stage ic-iii breast cancer, clinician      Pt w stgIC-3Brst ca rec tam 00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8381002004documented or prescribed that the patient is receiving tamoxifen or aromatase
G8381003004inhibitor
G8382001003Multiple myeloma patients with no documentation of prescribed or received       MM pt w/o doc IV bisphophon 00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8382002004intravenous bisphosphonate therapy
G8383001003No documentation of radiation therapy recommended within 12 months of first     No doc radiation rec 12mo ov00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8383002004office visit
G8384001003Baseline cytogenetic testing not performed in patients with myelodysplastic     Base cytogen test MDS notper00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8384002004syndrome (mds) or acute leukemias
G8385001003Diabetic patients with no documentation of hemoglobin a1c level (within the     Diabet pt no do Hgb A1c 12m 00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8385002004last 12 months)
G8386001003Diabetic patients with no documentation of low-density lipoprotein (within the  Diabet pt nodoc LDLiprotei  00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8386002004last 12 months)
G8387001003End-stage renal disease patient with a hematocrit or hemoglobin not documented  ESRD pt w Hct/Hgb not docume00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8388001003End-stage renal disease patient with urr or kt/v value not documented, but      ESRD pt w URR/Ktv notdoc eli00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8388002004otherwise eligible for measure
G8389001003Myelodysplastic syndrome (mds) patients with no documentation of iron stores    MDS pt no doc FE st prio EPO00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8389002004prior to receiving erythropoietin therapy
G8390001003Diabetic patients with no documentation of blood pressure measurement (within   Diabetic w/o document BP 12m00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8390002004the last 12 months)
G8391001003Patients with persistent asthma, no documentation of preferred long term        Pt w asthma no doc med or tx00      9                                                                                                     C                          M5D 1      0200707012011010120101231N
G8391002004control medication or acceptable alternative treatment prescribed
G8395001003Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or  LVEF>=40% doc normal or mild00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8395002004mildly depressed left ventricular systolic function
G8396001003Left ventricular ejection fraction (lvef) not performed or documented           LVEF not performed          00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8397001003Dilated macular or fundus exam performed, including documentation of the        Dil macula/fundus exam/w doc00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8397002004presence or absence of macular edema and level of severity of retinopathy
G8398001003Dilated macular or fundus exam not performed                                    Dil macular/fundus not perfo00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8399001003Patient with central dual-energy x-ray absorptiometry (dxa) results documented  Pt w/DXA document or order  00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8399002004or ordered or pharmacologic therapy (other than minerals/vitamins) for
G8399003004osteoporosis prescribed)
G8400001003Patient with central dual-energy x-ray absorptiometry (dxa) results not         Pt w/DXA no document or orde00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8400002004documented or not ordered or pharmacologic therapy (other than
G8400003004minerals/vitamins) for osteoporosis not prescribed, reason not given
G8401001003Clinician documented that patient was not an eligible candidate for screening   Pt inelig osteo screen measu00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8401002004or therapy for osteoporosis for women measure
G8402001003Tobacco (smoke) use cessation intervention, counseling                          Smoke preven interven counse00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8403001003Tobacco (smoke) use cessation intervention not counseled                        Smoke preven nocounsel      00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8404001003Lower extremity neurological exam performed and documented                      Low extemity neur exam docum00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8405001003Lower extremity neurological exam not performed                                 Low extemity neur not perfor00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8406001003Clinician documented that patient was not an eligible candidate for lower       Pt inelig lower extrem neuro00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8406002004extremity neurological exam measure
G8407001003Abi measured and documented                                                     ABI documented              00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8408001003Abi measurement was not obtained                                                ABI not documented          00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8409001003Clinician documented that patient was not an eligible candidate for abi         Pt inelig for ABI measure   00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8409002004measurement measure
G8410001003Footwear evaluation performed and documented                                    Eval on foot documented     00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8415001003Footwear evaluation was not performed                                           Eval on foot not performed  00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8416001003Clinician documented that patient was not an eligible candidate for footwear    Pt inelig footwear evaluatio00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8416002004evaluation measure
G8417001003Calculated bmi above normal parameters and a follow-up plan was documented      Calc BMI abv up param f/u   00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8418001003Calculated bmi below normal parameters and a follow-up plan was documented      Calc BMI blw low param f/u  00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8419001003Calculated bmi outside normal parameters, no follow-up plan documented          Calc BMI out nrm param nof/u00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8420001003Calculated bmi within normal parameters and documented                          Calc BMI norm parameters    00      9                                                                                                     C                          M5D 1      02008010120090101        N
G8421001003Bmi not calculated                                                              BMI not calculated          00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8422001003Patient not eligible for bmi calculation                                        Pt inelig BMI calculation   00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8423001003Documented that patient was screened and either influenza vaccination status is Pt screen flu vac & counsel 00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8423002004current or patient was counseled
G8424001003Influenza vaccine status was not screened                                       Flu vaccine not screen      00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8425001003Influenza vaccine status screened, patient not current and counseling was not   Flu vaccine screen not curre00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8425002004provided
G8426001003Documented that patient was not appropriate for screening and/or counseling     Pt not approp screen & counc00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8426002004about the influenza vaccine (e. G. , allergy to eggs)
G8427001003Eligible professional attests to documenting the patient's current medications  Doc cur meds by prov        00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8427002004to the best of his/her knowledge and ability
G8428001003Current medications not documented by the eligible professional, reason not     Cur meds not document       00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8428002004given
G8429001003Incomplete or no provider documentation that patient's current medications with Incomplete doc pt on meds   00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8429002004dosages (includes prescription, over-the-counter, herbals,
G8429003004vitamin/mineral/dietary [nutritional] supplements) were assessed
G8430001003Eligible professional attests the patient is not eligible for medication        Pt inelig med check         00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8430002004documentation
G8431001003Positive screen for clinical depression with a documented follow-up plan        Pos clin depres scrn f/u doc00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8432001003Clinical depression screening not documented, reason not given                  Clin depression screen not d00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8433001003Screening for clinical depression not documented, patient not                   Pt inelig; scrn clin dep    00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8433002004eligible/appropriate
G8434001003Documentation of cognitive impairment screening using a standardized tool       Cognitive impairment screen 00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8435001003No documentation of cognitive impairment screening using a standardized tool    Cognitive screen not documen00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8436001003Patient not eligible/not appropriate for cognitive impairment screening         Pt inelig for cognitive impa00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8437001003Documentation of clinician and patient involvement with the development of a    Care plan develop & document00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8437002004plan of care including signature by the practitioner/therapist and either a
G8437003004co-signature by the patient or documented verbal agreement obtained from the
G8437004004patient or, when necessary, an authorized representative
G8438001003No documentation of clinician and patient involvement with the development of a Pt inelig for devlp care pln00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8438002004plan of care including signature by the practitioner/therapist and either a
G8438003004co-signature by the patient or documented verbal agreement obtained from the
G8438004004patient or, when necessary, an authorized representative
G8439001003Documentation that patient is not eligible for co-developing a plan of care     Care plan develp & not docum00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8439002004including signature by the practitioner/therapist and either a co-signature by
G8439003004the patient or documented verbal agreement obtained from the patient or, when
G8439004004necessary, an authorized representative
G8440001003Documentation of pain assessment (including location, intensity and             Pain assess f/u pln document00      9                                                                                                     C                          M5D 1      0200801012012010120111231N
G8440002004description) prior to initiation of therapy or documentation of the absence of
G8440003004pain as a result of assessment through discussion with the patient including
G8440004004the use of a standardized tool and a follow-up plan is documented
G8441001003No documentation of pain assessment (including location, intensity and          No document of pain assess  00      9                                                                                                     C                          M5D 1      0200801012012010120111231N
G8441002004description) prior to initiation of therapy
G8442001003Documentation that patient is not eligible for pain assessment                  Pt inelig pain assessment   00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8443001003All prescriptions created during the encounter were generated using a qualified Prescription by E-Prescrib s00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8443002004e-prescribing system
G8445001003No prescriptions were generated during the encounter, provider does have access Prescrip not gen at encounte00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8445002004to a qualified e-prescribing system
G8446001003Provider does have access to a qualified e-prescribing system and some or all   Some prescrib print or call 00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8446002004of the prescriptions generated during the encounter were printed or phoned in
G8446003004as required by state or federal law or regulations, patient request or pharmacy
G8446004004system being unable to receive electronic transmission; or because they were
G8446005004for narcotics or other controlled substances
G8447001003Patient encounter was documented using an ehr system that has been certified by Pt vis doc use EHR cer ATCB 00      9                                                                                                     C                          M5D 1      0200801012013010120121231D
G8447002004an authorized testing and certification body (atcb)
G8448001003Patient encounter was documented using a pqri qualified ehr or other acceptable Pt vis doc w/PQRI qual EHR  00      9                                                                                                     C                          M5D 1      0200801012013010120121231D
G8448002004systems
G8449001003Patient encounter was not documented using an emr due to system reasons such    Pt not doc w/EMR due to syst00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8449002004as, the system being inoperable at the time of the visit; use of this code
G8449003004implies that an emr is in place and generally available
G8450001003Beta-blocker therapy prescribed                                                 Beta-bloc rx pt w/abn lvef  00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8451001003Clinician documented patient with left ventricular ejection fraction (lvef)     Pt w/abn lvef inelig b-bloc 00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8451002004<40% or documentation as moderately or severely depressed left ventricular
G8451003004systolic function was not eligible candidate for beta-blocker therapy
G8452001003Beta-blocker therapy not prescribed                                             Pt w/abn lvef b-bloc no rx  00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8453001003Tobacco use cessation intervention, counseling                                  Tob use cess int counsel    00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8454001003Tobacco use cessation intervention not counseled, reason not specified          Tob use cess int no counsel 00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8455001003Current tobacco smoker                                                          Current tobacco smoker      00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8456001003Current smokeless tobacco user                                                  Current smkless tobacco user00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8457001003Current tobacco non-user                                                        Cur tobacco non-user        00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8458001003Clinician documented that patient is not an eligible candidate for genotype     Pt inelig geno no antvir tx 00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8458002004testing; patient not receiving antiviral treatment for hepatitis c
G8459001003Clinician documented that patient is receiving antiviral treatment for          Doc pt rec antivir treat    00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8459002004hepatitis c
G8460001003Clinician documented that patient is not an eligible candidate for quantitative Pt inelig RNA no antvir tx  00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8460002004rna testing at week 12; patient not receiving antiviral treatment for hepatitis
G8460003004c
G8461001003Patient receiving antiviral treatment for hepatitis c                           Pt rec antivir treat hep c  00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8462001003Clinician documented that patient is not an eligible candidate for counseling   Pt inelig couns no antvir tx00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8462002004regarding contraception prior to antiviral treatment; patient not receiving
G8462003004antiviral treatment for hepatitis c
G8463001003Patient receiving antiviral treatment for hepatitis c documented                Pt rec antiviral treat doc  00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8464001003Clinician documented that prostate cancer patient is not an eligible candidate  Pt inelig; lo to no dter rsk00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8464002004for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk
G8464003004of recurrence not determined
G8465001003High risk of recurrence of prostate cancer                                      High risk recurrence pro ca 00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8466001003Clinician documented that patient is not an eligible candidate for suicide risk Pt inelig suic; MDD remis   00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8466002004assessment; major depressive disorder, in remission
G8467001003Documentation of new diagnosis of initial or recurrent episode of major         New dx init/rec episode MDD 00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8467002004depressive disorder
G8468001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   ACE/ARB rx pt w/abn lvef    00      9                                                                                                     C                          M5D 1      0200801012013010120121231D
G8468002004(arb) therapy prescribed for patients with a left ventricular ejection fraction
G8468003004(lvef) <40% or documentation of moderately or severely depressed left
G8468004004ventricular systolic function
G8469001003Clinician documented that patient with a left ventricular ejection fraction     Pt w/abn lvef inelig ACE/ARB00      9                                                                                                     C                          M5D 1      0200801012013010120121231D
G8469002004(lvef) <40% or documentation of moderately or severely depressed left
G8469003004ventricular systolic function was not an eligible candidate for angiotensin
G8469004004converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
G8470001003Patient with left ventricular ejection fraction (lvef) >=40% or documentation   Pt w/ normal lvef           00      9                                                                                                     C                          M5D 1      0200801012013010120121231D
G8470002004as normal or mildly depressed left ventricular systolic function
G8471001003Left ventricular ejection fraction (lvef) was not performed or documented       LVEF not performed/doc      00      9                                                                                                     C                          M5D 1      0200801012013010120121231D
G8472001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   ACE/ARB no rx pt w/abn lvef 00      9                                                                                                     C                          M5D 1      0200801012013010120121231D
G8472002004(arb) therapy not prescribed for patients with a left ventricular ejection
G8472003004fraction (lvef) <40% or documentation of moderately or severely depressed left
G8472004004ventricular systolic function, reason not specified
G8473001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   ACE/ARB thxpy rx'd          00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8473002004(arb) therapy prescribed
G8474001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   ACE/ARB not rx'd; doc reas  00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8474002004(arb) therapy not prescribed for reasons documented by the clinician
G8475001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   ACE/ARB thxpy not rx'd      00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8475002004(arb) therapy not prescribed, reason not given
G8476001003Most recent blood pressure has a systolic measurement of <130 mm/hg and a       BP sys <130 and dias <80    00      9                                                                                                     C                          M5D 1      02008010120080101        N
G8476002004diastolic measurement of <80 mm/hg
G8477001003Most recent blood pressure has a systolic measurement of >=130 mm/hg and/or a   BP sys>=130 and/or dias >=8000      9                                                                                                     C                          M5D 1      02008010120080101        N
G8477002004diastolic measurement of >=80 mm/hg
G8478001003Blood pressure measurement not performed or documented, reason not given        BP not performed/doc        00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8479001003Clinician prescribed angiotensin converting enzyme (ace) inhibitor or           MD rx'd ACE/ARB thxpy       00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8479002004angiotensin receptor blocker (arb) therapy
G8480001003Clinician documented that patient was not an eligible candidate for angiotensin Pt inelig ACE/ARB thxpy     00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8480002004converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
G8481001003Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or    MD not rx'd ACE/ARB thxpy   00      9                                                                                                     C                          M5D 1      0200801012011010120101231N
G8481002004angiotensin receptor blocker (arb) therapy, reason not specified
G8482001003Influenza immunization administered or previously received                      Flu immunize order/admin    00      9                                                                                                     C                          M5D 1      02008010120120101        N
G8483001003Influenza immunization was not ordered or administered for reasons documented   Flu imm no ord/admin doc rea00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8483002004by clinician (e. G. , patient allergy or other medical reason, patient declined
G8483003004or other patient reasons, or other system reasons)
G8484001003Influenza immunization was not ordered or administered, reason not given        Flu immunize no order/admin 00      9                                                                                                     C                          M5D 1      02008010120130101        C
G8485001003I intend to report the diabetes mellitus (dm) measures group                    Report, Diabetes measures   00      9                                                                                                     C                          M5D 1      02008070120130101        C
G8486001003I intend to report the preventive care measures group                           Report, Prev Care Measures  00      9                                                                                                     C                          M5D 1      02008070120080701        N
G8487001003I intend to report the chronic kidney disease (ckd) measures group              Report CKD Measures         00      9                                                                                                     C                          M5D 1      02008070120080701        N
G8488001003Clinician intends to report the end stage renal disease (esrd) measure group    Report ESRD Measures        00      9                                                                                                     C                          M5D 1      0200807012011010120101231N
G8489001003I intend to report the coronary artery disease (cad) measures group             CAD measures grp            00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8490001003I intend to report the rheumatoid arthritis (ra) measures group                 RA measures grp             00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8491001003I intend to report the hiv/aids measures group                                  HIV/AIDS measures grp       00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8492001003I intend to report the perioperative care measures group                        Periop Care measures grp    00      9                                                                                                     C                          M5D 1      02009010120100101        N
G8493001003I intend to report the back pain measures group                                 Back pain measures grp      00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8494001003All quality actions for the applicable measures in the diabetes mellitus (dm)   DM meas qual act perform    00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8494002004measures group have been performed for this patient
G8495001003All quality actions for the applicable measures in the chronic kidney disease   CKD meas qual act perform   00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8495002004(ckd) measures group have been performed for this patient
G8496001003All quality actions for the applicable measures in the preventive care measures Prev Care MG qual act perfrm00      9                                                                                                     C                          M5D 1      02009010120100101        N
G8496002004group have been performed for this patient
G8497001003All quality actions for the applicable measures in the coronary artery bypass   CABG meas qual act perform  00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8497002004graft (cabg) measures group have been performed for this patient
G8498001003All quality actions for the applicable measures in the coronary artery disease  CAD meas qual act perform   00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8498002004(cad) measures group have been performed for this patient
G8499001003All quality actions for the applicable measures in the rheumatoid arthritis     RA meas qual act perform    00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8499002004(ra) measures group have been performed for this patient
G8500001003All quality actions for the applicable measures in the hiv/aids measures group  HIV meas qual act perform   00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8500002004have been performed for this patient
G8501001003All quality actions for the applicable measures in the perioperative care       Perio meas qual act perform 00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8501002004measures group have been performed for this patient
G8502001003All quality actions for the applicable measures in the back pain measures group Back Pain MG qual act perfrm00      9                                                                                                     C                          M5D 1      02009010120100101        N
G8502002004have been performed for this patient
G8503001003Documentation that prophylactic antibiotic was given within one hour (if        Doc proph antibx w/in 1 hr  00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8503002004fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start
G8503003004of procedure when no incision is required)
G8504001003Documentation of order for prophylactic antibiotics to be given within one hour Doc ord pro antbx w/in 1 hr 00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8504002004(if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or
G8504003004start of procedure when no incision is required)
G8505001003Documentation that prophylactic antibiotic was not given within one hour (if    No doc proph antibx w/in 1hr00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8505002004fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start
G8505003004of procedure when no incision is required), reason not specified
G8506001003Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin  Pt rec ACE/ARB              00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8506002004receptor blocker (arb) therapy
G8507001003Provider documentation that patient is not eligible for patient verification of Pt inelig pt verif meds     00      9                                                                                                     C                          M5D 1      0200901012011010120101231N
G8507002004current medications
G8508001003Documentation of pain assessment (including location, intensity and             Pt inelig; pain asses no f/u00      9                                                                                                     C                          M5D 1      0200901012012010120111231N
G8508002004description) prior to initiation of therapy or documentation of the absence of
G8508003004pain as a result of assessment through discussion with the patient including
G8508004004the use of a standardized tool; no documentation of a follow-up plan, patient
G8508005004not eligible
G8509001003Documentation of positive pain assessment; no documentation of a follow-up      Pos pain assess no f/u doc  00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8509002004plan, reason not given
G8510001003Negative screen for clinical depression, follow-up not required                 Pt inelig neg scrn depres   00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8511001003Positive screen for clinical depression documented, follow up plan not          Clin depres scrn no f/u doc 00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8511002004documented, reason not given
G8512001003Pain severity quantified; pain present                                          Pain sev quant present      00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8513001003Abi measured and documented                                                     ABI meas & doc              00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8514001003Clinician documented that patient was not an eligible candidate for abi         PT inelig; ABI measure      00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8514002004measurement measure
G8515001003Abi measurement was not obtained                                                No ABI measurement          00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8516001003Patient screened for future falls risk; documentation of two or more falls in   Scrn fal rsk >2 fal or w/inj00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8516002004the past year or any fall with injury in the past year
G8517001003Patient screened for future fall risk; documentation of no falls in the past    Scrn fall rsk; <2 falls     00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8517002004year or only one fall without injury in the past year
G8518001003Clinical stage prior to surgery for lung cancer and esophageal cancer resection Clin stg b/f lun/eso ca surg00      9                                                                                                     C                          M5D 1      0200901012011010120101231N
G8518002004was recorded
G8519001003Clinician documented that patient was not eligible for clinical stage prior to  Pt in; clin ca stg b/f surg 00      9                                                                                                     C                          M5D 1      0200901012011010120101231N
G8519002004surgery for lung cancer and esophageal cancer resection measure
G8520001003Clinician stage prior to surgery for lung cancer and esophageal cancer          Clin stg b/f surg not doc   00      9                                                                                                     C                          M5D 1      0200901012011010120101231N
G8520002004resection was not recorded, reason not specified
G8521001003Antiplatelet therapy received (asa [81-325 mg/day] and/or clopidogrel [75       Antplt recd 48 hrs & disch  00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8521002004mg/day]) within 48 hours of the initiation of surgery and at discharge
G8522001003Clinician documented that patient was not an eligible candidate for             Pt inelig; antiplt therapy  00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8522002004antiplatelet therapy
G8523001003Antiplatelet therapy not received 48 hours prior to cea and at discharge,       Antplt not recd reas no spec00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8523002004reason not specified
G8524001003Patch closure used for patient undergoing conventional cea                      Patch closure conv CEA      00      9                                                                                                     C                          M5C 1      0200901012013010120121231D
G8525001003Clinician documented that patient did not receive conventional cea              No patch closure CEA        00      9                                                                                                     C                          M5D 1      0200901012013010120121231D
G8526001003Patch closure not used for patient undergoing conventional cea, reason not      No patch closure conv CEA   00      9                                                                                                     C                          M5D 1      0200901012013010120121231D
G8526002004specified
G8527001003Documentation of order for cefazolin or cefuroxime for antimicrobial prophylaxisDoc ord antimic prophy      00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8528001003Clinician documented that patient was ineligible for prophylactic antibiotic    Pt inelig; proph antibiot   00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8528002004selection measure
G8529001003Order for cefazolin or cefuroxime for antimicrobial prophylaxis not documented, No doc ord antimic prophy   00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8529002004reason not specified
G8530001003Autogenous av fistula received                                                  Auto AV fistula recd        00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8531001003Clinician documented that patient was not an eligible candidate for autogenous  Pt inelig; auto AV fistula  00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8531002004av fistula
G8532001003Clinician documented that patient recevied vascular access other than           No auto AV fistula; no reas 00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8532002004autogenous av fistula, reason not given
G8533001003Participation by a physician or other clinician in systematic clinical database Partic in clin data base reg00      9                                                                                                     C                          M5D 1      0200901012010010120091231N
G8533002004registry that includes consensus-endorsed quality measures
G8534001003Documentation of an elder maltreatment screen and follow-up plan                Doc elder mal scrn f/u plan 00      9                                                                                                     C                          M5D 1      0200901012012010120111231N
G8535001003No documentation of an elder maltreatment screen, patient not eligible          Pt inelig no eld mal scrn   00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8536001003No documentation of an elder maltreatment screen, reason not given              No doc elder mal scrn       00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8537001003Elder maltreatment screen documented, follow-up plan not documented, patient    Pt inelig eldmal scrn no f/u00      9                                                                                                     C                          M5D 1      0200901012012010120111231N
G8537002004not eligible
G8538001003Elder maltreatment screen documented, follow-up plan not documented, reason not Eld mal scrn no f/u pln     00      9                                                                                                     C                          M5D 1      0200901012012010120111231N
G8538002004specified
G8539001003Documentation of a functional outcome assessment using a standardized tool and  Doc funct and care plan     00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8539002004documentation of a care plan based on identified deficiencies on the date of
G8539003004functional outcome assessment
G8540001003Documentation that the patient is not eligible for a functional outcome         Pt inelig funct assess      00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8540002004assessment using a standardized tool
G8541001003Functional outcome assessment using a standardized tool not documented, reason  No doc cur funct assess     00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8541002004not given
G8542001003Documentation of a functional outcome assessment using a standardized tool; no  Doc funct no deficiencies   00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8542002004functional deficiencies identified, care plan not required
G8543001003Documentation of a functional outcome assessment using a standardized tool;     Cur funct asses; no care pln00      9                                                                                                     C                          M5D 1      02009010120130101        C
G8543002004care plan not documented, reason not given
G8544001003I intend to report the coronary artery bypass graft (cabg) measures group       CABG measures grp           00      9                                                                                                     C                          M5D 1      02009010120090101        N
G8545001003I intend to report the hepatitis c measures group                               HepC measures grp           00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8546001003I intend to report the community-acquired pneumonia (cap) measures group        CAP measures grp            00      9                                                                                                     C                          M5D 1      0201001012013010120121231D
G8547001003I intend to report the ischemic vascular disease (ivd) measures group           IVD measures grp            00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8548001003I intend to report the heart failure (hf) measures group                        HF measures grp             00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8549001003All quality actions for the applicable measures in the hepatitis c measures     HepC MG qual act perform    00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8549002004group have been performed for this patient
G8550001003All quality actions for the applicable measures in the community-acquired       CAP MG qual act perform     00      9                                                                                                     C                          M5D 1      0201001012013010120121231D
G8550002004pneumonia (cap) measures group have been performed for this patient
G8551001003All quality actions for the applicable measures in the heart failure (hf)       HF MG qual act perform      00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8551002004measures group have been performed for this patient
G8552001003All quality actions for the applicable measures in the ischemic vascular        IVD MG qual act perform     00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8552002004disease (ivd) measures group have been performed for this patient
G8553001003Prescription(s) generated and transmitted via a qualified erx system            Prescrip transmit via ERx sy00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8556001003Referred to a physician (preferably a physician with training in disorders of   Ref to doc otolog eval      00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8556002004the ear) for an otologic evaluation
G8557001003Patient is not eligible for the referral for otologic evaluation measure        Pt inelig ref otolog eval   00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8558001003Not referred to a physician (preferably a physician with training in disorders  No ref to doc otolog eval   00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8558002004of the ear) for an otologic evaluation, reason not given
G8559001003Patient referred to a physician (preferably a physician with training in        Pt ref doc oto eval         00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8559002004disorders of the ear) for an otologic evaluation
G8560001003Patient has a history of active drainage from the ear within the previous 90    Pt hx act drain prev 90 days00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8560002004days
G8561001003Patient is not eligible for the referral for otologic evaluation for patients   Pt inelig for ref oto eval  00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8561002004with a history of active drainage measure
G8562001003Patient does not have a history of active drainage from the ear within the      Pt no hx act drain 90 d     00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8562002004previous 90 days
G8563001003Patient not referred to a physician (preferably a physician with training in    Pt no ref oto reas no spec  00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8563002004disorders of the ear) for an otologic evaluation, reason not given
G8564001003Patient was referred to a physician (preferably a physician with training in    Pt ref oto eval             00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8564002004disorders of the ear) for an otologic evaluation, reason not specified)
G8565001003Verification and documentation of sudden or rapidly progressive hearing loss    Ver doc hear loss           00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8566001003Patient is not eligible for the "referral for otologic evaluation for sudden or Pt inelig ref oto eval      00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8566002004rapidly progressive hearing loss" measure
G8567001003Patient does not have verification and documentation of sudden or rapidly       Pt no doc hear loss         00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8567002004progressive hearing loss
G8568001003Patient was not referred to a physician (preferably a physician with training   Pt no ref otolo no spec     00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8568002004in disorders of the ear) for an otologic evaluation, reason not given
G8569001003Prolonged intubation (>24 hrs) required                                         Prol intubation req         00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8570001003Prolonged intubation (>24 hrs) not required                                     No prol intub req           00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8571001003Development of deep sternal wound infection within 30 days postoperatively      Ster wd ifx 30 d postop     00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8572001003No deep sternal wound infection                                                 No ster wd ifx              00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8573001003Stroke following isolated cabg surgery                                          Stk CABG                    00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8574001003No stroke following isolated cabg surgery                                       No strk CABG                00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8575001003Developed postoperative renal failure or required dialysis                      Postop ren fail             00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8576001003No postoperative renal failure/dialysis not required                            No postop ren fail          00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8577001003Re-exploration required due to mediastinal bleeding with or without tamponade,  Reop req bld grft oth       00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8577002004graft occlusion, valve dysfunction or other cardiac reason
G8578001003Re-exploration not required due to mediastinal bleeding with or without         No reop req bld grft oth    00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8578002004tamponade, graft occlusion, valve dysfunction or other cardiac reason
G8579001003Antiplatelet medication at discharge                                            Antplt med disch            00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8580001003Antiplatelet medication contraindicated                                         Antplt med contraind        00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8581001003No antiplatelet medication at discharge                                         no antplt med disch         00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8582001003Beta-blocker at discharge                                                       Bblock disch                00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8583001003Beta-blocker contraindicated                                                    Bblock contraind            00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8584001003No beta-blocker at discharge                                                    No bblock disch             00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8585001003Anti-lipid treatment at discharge                                               Antilipid treat disch       00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8586001003Anti-lipid treatment contraindicated                                            Antlip disch contra         00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8587001003No anti-lipid treatment at discharge                                            No antlipid treat disch     00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8588001003Most recent systolic blood pressure < 140 mmhg                                  Sys BP <140                 00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8589001003Most recent systolic blood pressure >= 140 mmhg                                 Sys BP >= 140               00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8590001003Most recent diastolic blood pressure < 90 mmhg                                  Dia BP < 90                 00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8591001003Most recent diastolic blood pressure >= 90 mmhg                                 Dia BP >= 90                00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8592001003No documentation of blood pressure measurement, reason not given                No BP measure               00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8593001003Lipid profile results documented and reviewed (must include total cholesterol,  Lipid pn results            00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8593002004hdl-c, triglycerides and calculated ldl-c)
G8594001003Lipid profile not performed, reason not given                                   No lipid prof perf          00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8595001003Most recent ldl-c < 100 mg/dl                                                   Ldl < 100                   00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8596001003Ldl-c was not performed                                                         No LDL perf                 00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8597001003Most recent ldl-c >= 100 mg/dl                                                  Ldl >= 100                  00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8598001003Aspirin or another antithrombotic therapy used                                  Asp therp used              00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8599001003Aspirin or another antithrombotic therapy not used, reason not given            No asp therp used           00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8600001003Iv t-pa initiated within three hours (<= 180 minutes) of time last known well   tPA initi w/in 3 hrs        00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8601001003Iv t-pa not initiated within three hours (<= 180 minutes) of time last known    No elig tPA init w/in 3 hrs 00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8601002004well for reasons documented by clinician
G8602001003Iv t-pa not initiated within three hours (<= 180 minutes) of time last known    No tPA init w/in 3 hrs      00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8602002004well, reason not given
G8603001003Score on the spoken language comprehension functional communication measure at  Spok lang comp score        00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8603002004discharge was higher than at admission
G8604001003Score on the spoken language comprehension functional communication measure at  No high score spok lang     00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8604002004discharge was not higher than at admission, reason not given
G8605001003Patient treated for spoken language comprehension but not scored on the spoken  No spok lang comp score     00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8605002004language comprehension functional communication measure either at admission or
G8605003004at discharge
G8606001003Score on the attention functional communication measure at discharge was higher Attention score             00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8606002004than at admission
G8607001003Score on the attention functional communication measure at discharge was not    No high score attention     00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8607002004higher than at admission, reason not given
G8608001003Patient treated for attention but not scored on the attention functional        No attention score          00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8608002004communication measure either at admission or at discharge
G8609001003Score on the memory functional communication measure at discharge was higher    Memory score                00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8609002004than at admission
G8610001003Score on the memory functional communication measure at discharge was not       No high score memory        00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8610002004higher than at admission, reason not given
G8611001003Patient treated for memory but not scored on the memory functional              No memory score             00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8611002004communication measure either at admission or at discharge
G8612001003Score on the motor speech functional communication measure at discharge was     Moto speech score           00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8612002004higher than at admission
G8613001003Score on the motor speech functional communication measure at discharge was not No high score moto speech   00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8613002004higher than at admission, reason not given
G8614001003Patient treated for motor speech but not scored on the motor speech             No moto speech score        00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8614002004comprehension functional communication measure either at admission or at
G8614003004discharge
G8615001003Score on the reading functional communication measure at discharge was higher   Reading score               00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8615002004than at admission
G8616001003Score on the reading functional communication measure at discharge was not      No high score reading       00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8616002004higher than at admission, reason not given
G8617001003Patient treated for reading but not scored on the reading functional            No reading score            00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8617002004communication measure either at admission or at discharge
G8618001003Score on the spoken language expression functional communication measure at     Spok lang exp score         00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8618002004discharge was higher than at admission
G8619001003Score on the spoken language expression functional communication measure at     No high score spok lang exp 00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8619002004discharge was not higher than at admission, reason not given
G8620001003Patient treated for spoken language expression but not scored on the spoken     No spok lang exp score      00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8620002004language expression functional communication measure either at admission or at
G8620003004discharge
G8621001003Score on the writing functional communication measure at discharge was higher   Writing score               00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8621002004than at admission
G8622001003Score on the writing functional communication measure at discharge was not      No high score writing       00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8622002004higher than at admission, reason not given
G8623001003Patient treated for writing but not scored on the writing functional            No writing score            00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8623002004communication measure either at admission or at discharge
G8624001003Score on the swallowing functional communication measure at discharge was       Swallowing score            00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8624002004higher than at admission
G8625001003Score on the swallowing functional communication measure at discharge was not   No high score swallowing    00      9                                                                                                     C                          M5D 1      02010010120130101        C
G8625002004higher than at admission, reason not given
G8626001003Patient treated for swallowing but not scored on the swallowing functional      No swallowing score         00      9                                                                                                     C                          M5D 1      02010010120120101        N
G8626002004communication measure at admission or at discharge
G8627001003Surgical procedure performed within 30 days following cataract surgery for      Surg proc w/in 30 days      00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8627002004major complications (e. G. Retained nuclear fragments, endophthalmitis,
G8627003004dislocated or wrong power iol, retinal detachment, or wound dehiscence)
G8628001003Surgical procedure not performed within 30 days following cataract surgery for  No surg proc w/in 30 days   00      9                                                                                                     C                          M5D 1      02010010120100101        N
G8628002004major complications (e. G. Retained nuclear fragments, endophthalmitis,
G8628003004dislocated or wrong power iol, retinal detachment, or wound dehiscence)
G8629001003Documentation of order for prophylactic parenteral antibiotic to be given       Doc antibio order b/4 surg  00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8629002004within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical
G8629003004incision (or start of procedure when no incision is required)
G8630001003Documentation that administration of prophylactic parenteral antibiotics was    Doc antibio given b/4 surg  00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8630002004initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior
G8630003004to surgical incision (or start of procedure when no incision is required), as
G8630004004ordered
G8631001003Clinician documented that patient was not an eligible candidate for ordering    Pt no elg 4 order antbi give00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8631002004prophylactic parenteral antibiotics to be given within one hour (if
G8631003004fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start
G8631004004of procedure when no incision is required)
G8632001003Prophylactic parenteral antibiotics were not ordered to be given or given       Doc no antibi order b/4 surg00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8632002004within one hour (if fluoroquinolone or vancomycin, two hours) prior to the
G8632003004surgical incision (or start of procedure when no incision is required), reason
G8632004004not given
G8633001003Pharmacologic therapy (other than minierals/vitamins) for osteoporosis          Pharm ther osteo rx         00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8633002004prescribed
G8634001003Clinician documented patient not an eligible candidate to receive pharmacologic Pt no elg phar ther osteo   00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8634002004therapy for osteoporosis
G8635001003Pharmacologic therapy for osteoporosis was not prescribed, reason not given     No pharm ther osteo rx      00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8636001003Influenza immunization administered or previously received                      Flu immun admin/prev rec    00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8637001003Clinician documented that patient is not eligible to receive the influenza      Pt no elg receiv flu immun  00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8637002004immunization
G8638001003Influenza immunization not administered or previously received, reason not      Flu immun no admin/prev rec 00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8638002004otherwise specified
G8639001003Influenza immunization was administered or previously received                  Flu immun admin or prev rec 00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8640001003Clinician has documented that patient is not eligible to receive the influenza  Pt no elg rec flu immun     00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8640002004immunization
G8641001003Influenza immunization was not administered or previously received, reason not  Flu immun not admin/pre rec 00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8641002004otherwise specified
G8642001003The eligible professional practices in a rural area without sufficient high     Hrdshp rural w/o internet   00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8642002004speed internet access and requests a hardship exemption from the application of
G8642003004the payment adjustment under section 1848(a)(5)(a) of the social security act
G8643001003The eligible professional practices in an area without sufficient available     Hrdshp w/o suff pharm w/eRx 00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8643002004pharmacies for electronic prescribing and requests a hardship exemption for the
G8643003004application of the payment adjustment under section 1848(a)(5)(a) of the social
G8643004004security act
G8644001003Eligible professional does not have prescribing privileges                      EP no prescribe priv        00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8645001003I intend to report the asthma measures group                                    Asthma measures grp         00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8646001003All quality actions for the applicable measures in the asthma measures group    Asthma MG qual act perform  00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8646002004have been performed for this patient
G8647001003Risk-adjusted functional status change residual score for the knee successfully Fun stat score knee >= 0    00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8647002004calculated and the score was equal to zero (0) or greater than zero (>0)
G8648001003Risk-adjusted functional status change residual score for the knee successfully Fun stat score knee < 0     00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8648002004calculated and the score was less than zero (<0)
G8649001003Risk-adjusted functional status change residual scores for the knee not         Fun stat score knee pt noelg00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8649002004measured because the patient did not complete foto's functional intake on
G8649003004admission and/or follow up status survey near discharge, patient not
G8649004004eligible/not appropriate
G8650001003Risk-adjusted functional status change residual scores for the knee not         Fun stat score knee not done00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8650002004measured because the patient did not complete foto's functional intake on
G8650003004admission and/or follow up status survey near discharge, reason not given
G8651001003Risk-adjusted functional status change residual score for the hip successfully  Fun stat score hip >= 0     00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8651002004calculated and the score was equal to zero (0) or greater than zero (>0)
G8652001003Risk-adjusted functional status change residual score for the hip successfully  Fun stat score hip < 0      00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8652002004calculated and the score was less than zero (<0)
G8653001003Risk-adjusted functional status change residual scores for the hip not measured Fun stat score hip pt no elg00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8653002004because the patient did not complete foto's functional intake on admission
G8653003004and/or follow up status survey near discharge, patient not eligible/not
G8653004004appropriate
G8654001003Risk-adjusted functional status change residual scores for the hip not measured Fun stat score hip not done 00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8654002004because the patient did not complete foto's functional intake on admission
G8654003004and/or follow up status survey near discharge, reason not given
G8655001003Risk-adjusted functional status change residual score for the lower leg, foot   Fun stat score LE >= 0      00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8655002004or ankle successfully calculated and the score was equal to zero (0) or greater
G8655003004than zero(>0)
G8656001003Risk-adjusted functional status change residual score for the lower leg, foot   Fun stat score LE < 0       00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8656002004or ankle successfully calculated and the score was less than zero (<0)
G8657001003Risk-adjusted functional status change residual scores for the lower leg, foot  Fun stat score LE pt no elg 00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8657002004or ankle not measured because the patient did not complete foto's functional
G8657003004intake on admission and/or follow up status survey near discharge, patient not
G8657004004eligible/not appropriate
G8658001003Risk-adjusted functional status change residual scores for the lower leg, foot  Fun stat score LE not done  00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8658002004or ankle not measured because the patient did not complete foto's functional
G8658003004intake on admission and/or follow up status survey near discharge, reason not
G8658004004given
G8659001003Risk-adjusted functional status change residual score for the lumbar spine      Fun stat score LS >= 0      00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8659002004successfully calculated and the score was equal to zero (0) or greater than
G8659003004zero (>0)
G8660001003Risk-adjusted functional status change residual score for the lumbar spine      Fun stat score LS < 0       00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8660002004successfully calculated and the score was less than zero (<0)
G8661001003Risk-adjusted functional status change residual scores for the lumbar spine not Fun stat score LS pt no elg 00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8661002004measured because the patient did not complete foto's functional intake on
G8661003004admission and/or follow up status survey near discharge, patient not
G8661004004eligible/not appropriate
G8662001003Risk-adjusted functional status change residual scores for the lumbar spine not Fun stat score LS not done  00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8662002004measured because the patient did not complete foto's functional intake on
G8662003004admission and/or follow up status survey near discharge, reason not given
G8663001003Risk-adjusted functional status change residual score for the shoulder          Fun stat score shdl >=0     00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8663002004successfully calculated and the score was equal to zero (0) or greater than
G8663003004zero (>0)
G8664001003Risk-adjusted functional status change residual score for the shoulder          Fun stat score shdl < 0     00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8664002004successfully calculated and the score was less than zero (<0)
G8665001003Risk-adjusted functional status change residual scores for the shoulder not     Fun stat score shdl pt no el00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8665002004measured because the patient did not complete foto's functional intake on
G8665003004admission and/or follow up status survey near discharge, patient not
G8665004004eligible/not appropriate
G8666001003Risk-adjusted functional status change residual scores for the shoulder not     Fun stat score shdl not done00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8666002004measured because the patient did not complete foto's functional intake on
G8666003004admission and/or follow up status survey near discharge, reason not given
G8667001003Risk-adjusted functional status change residual score for the elbow, wrist or   Fun stat score UE >=0       00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8667002004hand successfully calculated and the score was equal to zero (0) or greater
G8667003004than zero (>0)
G8668001003Risk-adjusted functional status change residual score for the elbow, wrist or   Fun stat score UE < 0       00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8668002004hand successfully calculated and the score was less than zero (<0)
G8669001003Risk-adjusted functional status change residual scores for the elbow, wrist or  Fun stat score UE pt no elg 00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8669002004hand not measured because the patient did not complete foto's functional intake
G8669003004on admission and/or follow up status survey near discharge, patient not
G8669004004eligible/not appropriate
G8670001003Risk-adjusted functional status change residual scores for the elbow, wrist or  Fun stat score UE not done  00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8670002004hand not measured because the patient did not complete foto's functional intake
G8670003004on admission and/or follow up status survey near discharge, reason not given
G8671001003Risk-adjusted functional status change residual score for the neck, cranium,    Fun stat score neck/TS >=0  00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8671002004mandible, thoracic spine, ribs, or other general orthopedic impairment
G8671003004successfully calculated and the score was equal to zero (0) or greater than
G8671004004zero (>0)
G8672001003Risk-adjusted functional status change residual score for the neck, cranium,    Fun stat score neck/TS < 0  00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8672002004mandible, thoracic spine, ribs, or other general orthopedic impairment
G8672003004successfully calculated and the score was less than zero (<0)
G8673001003Risk-adjusted functional status change residual scores for the neck, cranium,   Fun stat scor nek/TS pt no e00      9                                                                                                     C                          M5B 1      02011010120110101        N
G8673002004mandible, thoracic spine, ribs, or other general orthopedic impairment not
G8673003004measured because the patient did not complete foto's functional intake on
G8673004004admission and/or follow up status survey near discharge, patient not
G8673005004eligible/not appropriate
G8674001003Risk-adjusted functional status change residual scores for the neck, cranium,   Fun stat scor nek/TS not don00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8674002004mandible, thoracic spine, ribs, or other general orthopedic impairment not
G8674003004measured because the patient did not complete foto's functional intake on
G8674004004admission and/or follow up status survey near discharge, reason not given
G8675001003Most recent systolic blood pressure >= 140 mm hg                                BP Syst >= 140 mmHg         00      9                                                                                                     C                          M5B 1      0201101012013010120121231D
G8676001003Most recent diastolic blood pressure >= 90 mm hg                                BP Diast >= 90 mmHg         00      9                                                                                                     C                          M5B 1      0201101012013010120121231D
G8677001003Most recent systolic blood pressure < 130 mm hg                                 BP Syst < 130 mmHg          00      9                                                                                                     C                          M5B 1      0201101012013010120121231D
G8678001003Most recent systolic blood pressure 130 to 139 mm hg                            BP Syst >=130 - 139 mmHg    00      9                                                                                                     C                          M5B 1      0201101012013010120121231D
G8679001003Most recent diastolic blood pressure < 80 mm hg                                 BP Diast < 80 mmHg          00      9                                                                                                     C                          M5B 1      0201101012013010120121231D
G8680001003Most recent diastolic blood pressure 80 - 89 mm hg                              BP Diast 80-89 mmHg         00      9                                                                                                     C                          M5B 1      0201101012013010120121231D
G8681001003Patient hospitalized with principal diagnosis of heart failure during the       Pt hosp w/HF                00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8681002004measurement period
G8682001003Lvf testing performed during the measurement period                             LVG test perf               00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8683001003Lvf testing not performed, patient not eligible                                 Pt not elig for LVF test    00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8684001003Patient not hospitalized with principal diagnosis of heart failure during the   Pt not hosp w/HF            00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8684002004measurement period
G8685001003Lvf testing not performed, reason not given                                     LVF test not perf           00      9                                                                                                     C                          M5B 1      02011010120130101        C
G8686001003Currently a tobacco smoker or current exposure to secondhand smoke              Toba smkr curr or 2 hand exp00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8687001003Currently a tobacco non-user and no exposure to secondhand smoke                No tob smkr cur no 2 hnd exp00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8688001003Currently a smokeless tobacco user (eg, chew, snuff) and no exposure to         Smkls tob cur; no 2 hnd exp 00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8688002004secondhand smoke
G8689001003Tobacco use not assessed, reason not otherwise specified                        Toba use not assess         00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8690001003Current tobacco smoker or current exposure to secondhand smoke                  Curr toba smkr or 2 hand exp00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8691001003Current tobacco non-user and no exposure to secondhand smoke                    No cur tob smkr no 2 hnd exp00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8692001003Current smokeless tobacco user (eg, chew, snuff) and no exposure to secondhand  Curr smkls tob; no 2 hnd exp00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8692002004smoke
G8693001003Tobacco use not assessed, reason not specified                                  Tobacco no assess           00      9                                                                                                     C                          M5B 1      0201101012012010120111231N
G8694001003Left ventriucular ejection fraction (lvef) < 40%                                Lvef <40%                   00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8695001003Left ventricular ejection fraction (lvef) >= 40% or documentation as mildly     Lvef >=40%                  00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8695002004depressed left ventricular systolic function or normal
G8696001003Antithrombotic therapy prescribed at discharge                                  Antithromb thx presc        00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8697001003Antithrombotic therapy not prescribed for documented reasons (e. G. , patients  Antithromb no presc doc reas00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8697002004admitted for performance of elective carotid intervention, patient had stroke
G8697003004during hospital stay, patient expired during inpatient stay, other medical
G8697004004reason(s)); (e. G. , patient left against medical advice, other patient
G8697005004reason(s))
G8698001003Antithrombotic therapy was not prescribed at discharge, reason not given        Antithromb no presc no reas 00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8699001003Rehabilitation services (occupational, physical or speech) ordered at or prior  Rehab ordered disch         00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8699002004to discharge
G8700001003Rehabilitation services (occupational, physical or speech) not indicated at or  Rehab not indicated disch   00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8700002004prior to discharge
G8701001003Rehabilitation services were not ordered, reason not otherwise specified        Rehab not ordered           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8702001003Documentation that prophylactic antibiotics were given within 4 hours prior to  Antiobiotics 4 hr prior surg00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8702002004surgical incision or intraoperatively
G8703001003Documentation that prophylactic antibiotics were neither given within 4 hours   Antibiotics not prior surg  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8703002004prior to surgical incision nor intraoperatively
G870400100312-lead electrocardiogram (ecg) performed                                       ECG performed               00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8705001003Documentation of medical reason(s) for not performing a 12-lead                 Med reas no ECG             00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8705002004electrocardiogram (ecg)
G8706001003Documentation of patient reason(s) for not performing a 12-lead                 Pt reas no ECG              00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8706002004electrocardiogram (ecg)
G870700100312-lead electrocardiogram (ecg) not performed, reason not given                 ECG not performed           00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8708001003Patient not prescribed or dispensed antibiotic                                  Antibiotic not pres         00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8709001003Patient prescribed or dispensed antibiotic for documented medical reason(s)     Med reas antibiotic pres    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8710001003Patient prescribed or dispensed antibiotic                                      Pt pres antibiotic          00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8711001003Prescribed or dispensed antibiotic                                              Pres antibiotic             00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8712001003Antibiotic not prescribed or dispensed                                          Not pres antibiotic         00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8713001003Spkt/v greater than or equal to 1. 2 (single-pool clearance of urea [kt] /      SpKt/V great 1.2 Kt/V       00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8713002004volume [v])
G8714001003Hemodialysis treatment performed exactly three times per week for > 90 days     Hemodialysis 3 times week   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8715001003Hemodialysis treatment performed less than three times per week or greater than Hemodialysis not 3 times wk 00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8715002004three times per week
G8716001003Documentation of reason(s) for patient not having greater than or equal to 1. 2 Pt reas not great 1.2Kt/V   00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8716002004(single-pool clearance of urea [kt] / volume [v])
G8717001003Spkt/v less than 1. 2 (single-pool clearance of urea [kt] / volume [v]), reason Less 1.2 Kt/V               00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8717002004not given
G8718001003Total kt/v greater than or equal to 1. 7 per week (total clearance of urea [kt] Great 1.7 Kt/V per week     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8718002004/ volume [v])
G8720001003Total kt/v less than 1. 7 per week (total clearance of urea [kt] / volume [v]), Less 1.7 Kt/V per week      00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8720002004reason not given
G8721001003Pt category (primary tumor), pn category (regional lymph nodes), and histologic Pt, pn, hist grade doc      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8721002004grade were documented in pathology report
G8722001003Medical reason(s) documented for not including pt category, pn category and     Med reas pt, pn, not doc    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8722002004histologic grade in the pathology report (e. G. , anal canal)
G8723001003Specimen site is other than anatomic location of primary tumor                  Spec sit not prim tumor     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8724001003Pt category, pn category and histologic grade were not documented in the        Pt, pn, hist grade not doc  00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8724002004pathology report, reason not given
G8725001003Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total          Lipid profile perf doc      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8725002004cholesterol)
G8726001003Clinician has documented reason for not performing fasting lipid profile (e. G. Doc reas no lipid profile   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8726002004, patient declined, other patient reasons)
G8727001003Patient receiving hemodialysis, peritoneal dialysis or kidney transplantation   Hemo, perit, or kidney trans00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8728001003Fasting lipid profile not performed, reason not given                           Lipid profile not perf      00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8730001003Pain assessment documented as positive utilizing a standardized tool and a      Pain doc pos and plan       00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8730002004follow-up plan is documented
G8731001003Pain assessment documented as negative, no follow-up plan is required           Pain neg no plan            00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8732001003No documentation of pain assessment, reason not given                           No doc of pain              00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8733001003Documentation of a positive elder maltreatment screen and documented follow-up  Doc pos elder mal scrn plan 00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8733002004plan at the time of the positive screen
G8734001003Elder maltreatment screen documented as negative, no follow-up required         Doc neg elder mal no plan   00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8735001003Elder maltreatment screen documented as positive, follow-up plan not            Eld mal scrn pos no plan    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8735002004documented, reason not given
G8736001003Most current ldl-c <100mg/dl                                                    LDL-C <100mg/dL             00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8737001003Most current ldl-c >=100mg/dl                                                   LDL-C >=100mg/dL            00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8738001003Left ventricular ejection fraction (lvef) < 40% or documentation of severely or Lvef < 40%                  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8738002004moderately depressed left ventricular systolic function
G8739001003Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or  Lvef >= 40%                 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8739002004mildly depressed left ventricular systolic function
G8740001003Left ventricular ejection fraction (lvef) not performed or assessed, reason not LVEF not perfrmd            00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8740002004given
G8741001003Patient not treated for spoken language comprehension disorder                  Not tx spoken lang          00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8742001003Patient not treated for attention disorder                                      Not tx attention            00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8743001003Patient not treated for memory disorder                                         Not tx memory               00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8744001003Patient not treated for motor speech disorder                                   Not tx motor speech         00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8745001003Patient not treated for reading disorder                                        Not tx reading              00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8746001003Patient not treated for spoken language expression disorder                     Not tx spoken lang express  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8747001003Patient not treated for writing disorder                                        Not tx writing              00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8748001003Patient not treated for swallowing disorder                                     Not tx swallowing           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8749001003Absence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic  Signs of melanoma absent    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8749002004signs such as weakness, jaundice or any other sign suggesting systemic spread)
G8749003004or absence of symptoms of melanoma (pain, paresthesia, or any other symptom
G8749004004suggesting the possibility of systemic spread of melanoma)
G8750001003Presence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic Signs of melanoma present   00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8750002004signs such as weakness, jaundice or any other sign suggesting systemic spread)
G8750003004or presence of symptoms of melanoma (pain, paresthesia, or any other symptom
G8750004004suggesting the possibility of systemic spread of melanoma)
G8751001003Smoking status and exposure to second hand smoke in the home not assessed,      Smkg status not assess      00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8751002004reason not given
G8752001003Most recent systolic blood pressure < 140mmhg                                   Sys BP less 140             00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8753001003Most recent systolic blood pressure >= 140mmhg                                  Sys BP > or = 140           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8754001003Most recent diastolic blood pressure < 90mmhg                                   Dias BP less 90             00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8755001003Most recent diastolic blood pressure >= 90mmhg                                  Dias BP > or = 90           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8756001003No documentation of blood pressure measurement, reason not given                No BP measure doc           00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8757001003All quality actions for the applicable measures in the chronic obstructive      COPD MG qual act perform    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8757002004pulmonary disease (copd) measures group have been performed for this patient
G8758001003All quality actions for the applicable measures in the inflammatory bowel       IBD MG qual act perform     00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8758002004disease (ibd) measures group have been performed for this patient
G8759001003All quality actions for the applicable measures in the sleep apnea measures     OSA MG qual act perform     00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8759002004group have been performed for this patient
G8760001003All quality actions for the applicable measures in the epilepsy measures group  Epilepsy MG qual act perform00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8760002004have been performed for this patient
G8761001003All quality actions for the applicable measures in the dementia measures group  Dementia MG qual act perform00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8761002004have been performed for this patient
G8762001003All quality actions for the applicable measures in the parkinson's disease      PD MG qual act perform      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8762002004measures group have been performed for this patient
G8763001003All quality actions for the applicable measures in the hypertension (htn)       Hyperten MG qual act perform00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8763002004measures group have been performed for this patient
G8764001003All quality actions for the applicable measures in the cardiovascular           Car Prev MG qual act perform00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8764002004prevention measures group have bee performed for this patient
G8765001003All quality actions for the applicable measures in the cataract measures group  Cataract MG qual act perform00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8765002004have been performed for this patient
G8767001003Lipid panel results documented and reviewed (must include total cholesterol,    Lipid panel res doc rev     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8767002004hdl-c, triglycerides and calculated ldl-c)
G8768001003Documentation of medical reason(s) for not performing lipid profile (e. G.      Doc med reas no lipid profle00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8768002004Patients who have a terminal illness or for whom treatment of hypertension with
G8768003004standard treatment goals is not clinically appropriate)
G8769001003Lipid profile not performed, reason not given                                   Lipid profile not perform   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8770001003Urine protein test result documented and reviewed                               Urine protein test doc rev  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8771001003Documentation of diagnosis of chronic kidney disease                            Doc dx CKD                  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8772001003Documentation of medical reason(s) for not performing urine protein test (e. G. Doc med reas no urine protn 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8772002004Patients who have a terminal illness or for whom treatment of hypertension with
G8772003004standard treatment goals is not cllinically appropriate)
G8773001003Urine protein test was not performed, reason not given                          No urine protein test       00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8774001003Serum creatinine test result documented and reviewed                            Serum creatinine doc rev    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8775001003Documentation of medical reason(s) for not performing serum creatinine test (e. Doc med reas no serum crtn  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8775002004G. Patients who have a terminal illness or for whom treatment of hypertension
G8775003004with standard treatment goals is not clinically appropriate)
G8776001003Serum creatinine test not performed, reason not given                           No serum creatinine test    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8777001003Diabetes screening test performed                                               Diabetes screen             00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8778001003Documentation of medical reason(s) for not performing diabetes screening test   Doc med reas no diabete scrn00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8778002004(e. G. Patients who have a terminal illness or for whom treatment of
G8778003004hypertension with standard treatment goals is not clinically appropriate, or
G8778004004patients with a diagnosis of diabetes)
G8779001003Diabetes screening test not performed, reason not given                         No diabetes screen          00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8780001003Counseling for diet and physical activity performed                             Counsel diet phys activity  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8781001003Documentation of medical reason(s) for patient not receiving counseling for     Doc med reas no counsel diet00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8781002004diet and physical activity (e. G. Patients who have a terminal illness or for
G8781003004whom treatment of hypertension with standard treatment goals is not clinically
G8781004004appropriate)
G8782001003Counseling for diet and physical activity not performed, reason not given       No counsel diet phys act    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8783001003Normal blood pressure reading documented, follow-up not required                BP scrn perf rec interval   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8784001003Blood pressure reading not documented, patient not eligible/not appropriate     Pt no elig for BP assess    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8785001003Blood pressure reading not documented, reason not given                         BP scrn no perf at interval 00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8786001003Severity of angina assessed according to level of activity                      Severity of angina assess   00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8787001003Angina assessed as present                                                      Angina present              00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8788001003Angina assessed as absent                                                       Angina absent               00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8789001003Severity of angina not assessed according to level of activity                  Severity angina not assess  00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8790001003Most recent office visit systolic blood pressure <130 mm hg                     Systolic <130mmHg           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8791001003Most recent office visit systolic blood pressure, 130 to 139 mm hg              Systolic 130-139mmHg        00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8792001003Most recent office visit systolic blood pressure >=140 mm hg                    Systolic >=140mmHg          00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8793001003Most recent office visit diastolic blood pressure, <80 mm hg                    Diastolic <80mmHg           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8794001003Most recent office visit diastolic blood pressure, 80 - 89 mm hg                Diastolic 80-89mmHg         00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8795001003Most recent office visit diastolic blood pressure >=90 mm hg                    Diastolic >=90mmHg          00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8796001003Blood pressure measurement not documented, reason not given                     BP not doc                  00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8797001003Specimen site other than anatomic location of esophagus                         Specimen site not esophagus 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8798001003Specimen site other than anatomic location of prostate                          Specimen site not prostate  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8799001003Anticoagulation ordered                                                         Anticoag ordered            00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8800001003Anticoagulation not ordered for reasons documented by clinician                 Doc reas anticoag not order 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8801001003Anticoagulation was not ordered, reason not given                               Anticoag not ordered        00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8802001003Pregnancy test (urine or serum) ordered                                         Pregnancy test order        00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8803001003Pregnancy test (urine or serum) not ordered for reasons documented by clinician Doc reas no pregnancy test  00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8805001003Pregnancy test (urine or serum) was not ordered, reason not specified           Pregnancy test not order    00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8806001003Performance of trans-abdominal or trans-vaginal ultrasound                      Transab or transvag US      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8807001003Trans-abdominal or trans-vaginal ultrasound not performed for reasons           Doc reas no US              00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8807002004documented by clinician (e. G. , patient has visited the ed multiple times
G8807003004within 72 hours, patient has a documented intrauterine pregnancy [iup])
G8808001003Performance of trans-abdominal or trans-vaginal ultrasound not ordered, reason  No transab or transvag US   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8808002004not given
G8809001003Rh-immunoglobulin (rhogam) ordered                                              Rh-immunoglobulin order     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8810001003Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.  Doc reas no Rh-immuno       00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8810002004G. , patient had prior documented receipt of rhogam within 12 weeks)
G8811001003Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given      No Rh-immunoglobulin order  00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8812001003Patient is not eligible for follow-up cta, duplex, or mra (e. G. , patient      Pt not elig CTA, duplex, MRA00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8812002004death, failure to return for scheduled follow-up exam, planned follow-up study
G8812003004which will meet numerator criteria has not yet occurred at the time of
G8812004004reporting)
G8813001003Follow-up cta, duplex, or mra of the abdomen and pelvis performed               CTA, duplex, MRA performed  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8814001003Follow-up cta, duplex, or mra of the abdomen and pelvis not performed           No CTA, duplex, MRA         00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8815001003Statin therapy not prescribed for documented reasons (e. G. , medical           Doc reas no statin therapy  00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8815002004intolerance to statin, death of patient prior to discharge, transfer of care to
G8815003004another acute care or federal hospital, hospice admission, left against medical
G8815004004advice)
G8816001003Statin medication prescribed at discharge                                       Statin med pres at disch    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8817001003Statin therapy not prescribed at discharge, reason not given                    Doc reas no statin med disch00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8818001003Patient discharge to home no later than post-operative day #7                   Pt disch to home by day#7   00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8819001003Aneurysm minor diameter <= 5. 5 cm                                              Aneurysm <= 5.5 cm          00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8820001003Aneurysm minor diameter 5. 6-6. 0 cm                                            Aneurysm 5.6-6.0 cm         00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8821001003Abdominal aortic aneurysm is not infarenal                                      Aneurysm not infarenal      00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8822001003Male patients with aneurysms minor diameter >6 cm                               Male aneurysms >6cm         00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8823001003Female patients with aneurysm minor diameter >6cm                               Female aneurysm >6cm        00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8824001003Female patients with aneurysm minor diameter 5. 6-6. 0 cm                       Female aneurysm 5.6-6.0 cm  00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8825001003Patient not discharged to home by post-operative day #7                         Pt not disch to home day#7  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8826001003Patient discharge to home no later than post-operative day #2 following evar    Pt disch home day #2 EVAR   00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8827001003Aneurysm minor diameter <= 5. 5 cm for women                                    Aneurysm <= 5.5cm for women 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8828001003Aneurysm minor diameter <= 5. 5 cm for men                                      Aneurysm <= 5.5cm for men   00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8829001003Aneurysm minor diameter 5. 6-6. 0 cm for men                                    Aneurysm 5.6-6.0 cm for men 00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8830001003Aneurysm minor diameter >6cm for men                                            Aneurysm >6cm for men       00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8831001003Aneurysm minor diameter >6cm for women                                          Aneurysm >-6cm  for women   00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8832001003Aneurysm minor diameter 5. 6-6. 0 cm for women                                  Aneurysm 5.6-6.0 women      00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8833001003Patient not discharged to home by post-operative day #2 following evar          Pt not disch home day#2 EVAR00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8834001003Patient discharged to home no later than post-operative day #2 following cea    Pt disch home day #2 CEA    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8835001003Asymptomatic patient with no history of any transient ischemic attack or stroke Asymptom no trans           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8835002004in any carotid or vertebrobasilar territory
G8836001003Symptomatic patient with ipsilateral stroke or tia within 120 days prior to cea Stroke or TIA <120 days CEA 00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8837001003Other symptomatic patient with ipsilateral carotid territory tia or stroke >    Stroke or TIA >120 days CEA 00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8837002004120 days prior to cea, or contralateral carotid territory tia or stroke or
G8837003004vertebrobasilar tia or stroke
G8838001003Patient not discharged to home by post-operative day #2 following cea           Not disch home by day #2    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8839001003Sleep apnea symptoms assessed, including presence or absence of snoring and     Sleep apnea assess          00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8839002004daytime sleepiness
G8840001003Documentation of reason(s) for not performing an assessment of sleep symptoms   Doc reas no sleep apnea     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8840002004(e. G. , patient didn't have initial daytime sleepiness, patient visits between
G8840003004initial testing and initiation of therapy)
G8841001003Sleep apnea symptoms not assessed, reason not given                             No sleep apnea assess       00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8842001003Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) measured at   AHI or RDI initial dx       00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8842002004the time of initial diagnosis
G8843001003Documentation of reason(s) for not measuring an apnea hypopnea index (ahi) or a Doc reas no AHI or RDI      00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8843002004respiratory disturbance index (rdi) at the time of initial diagnosis (e. G. ,
G8843003004abnormal anatomy, patient declined, financial, insurance coverage)
G8844001003Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured  No AHI or RDI initial dx    00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8844002004at the time of initial diagnosis, reason not given
G8845001003Positive airway pressure therapy prescribed                                     Pos Airway Press prescribed 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8846001003Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or       Mod or severe OSA           00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8846002004respiratory disturbance index (rdi) of 15 or greater)
G8847001003Positive airway pressure therapy not prescribed                                 Pos Air Press not prescribed00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8848001003Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory         Mild OSA                    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8848002004disturbance index (rdi) of less than 15)
G8849001003Documentation of reason(s) for not prescribing positive airway pressure therapy Doc reas no Pos Air Press   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8849002004(e. G. , patient unable to tolerate, alternative therapies use, patient
G8849003004declined, financial, insurance coverage)
G8850001003Positive airway pressure therapy not prescribed, reason not given               No PAP prescribed           00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8851001003Objective measurement of adherence to positive airway pressure therapy,         Adhere Pos Air Press therapy00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8851002004documented
G8852001003Positive airway pressure therapy prescribed                                     Pos Air Press prescribe     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8853001003Positive airway pressure therapy not prescribed                                 Pos Air Press not prescribe 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8854001003Documentation of reason(s) for not objectively measuring adherence to positive  Reas no adhere Pos Air Pres 00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8854002004airway pressure therapy (e. G. , patient didn't bring data from continous
G8854003004positive airway pressure [cpap], therapy not yet initiated, not available on
G8854004004machine)
G8855001003Objective measurement of adherence to positive airway pressure therapy not      Pos Air Press adhere no perf00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8855002004performed, reason not given
G8856001003Referral to a physician for an otologic evaluation performed                    Ref for oto eval            00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8857001003Patient is not eligible for the referral for otologic evaluation measure (e. G. No elig ref for oto eval    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8857002004, patients who are already under the care of a physician for acute or chronic
G8857003004dizziness)
G8858001003Referral to a physician for an otologic evaluation not performed, reason not    Not ref for oto eval        00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8858002004given
G8859001003Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or   Corticosteroids 10mg 60 days00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8859002004greater consecutive days
G8860001003Patients who have received dose of corticosteroids greater than or equal to     Corticosteroid 10 mg 60 days00      9                                                                                                     C                          M5B 1      02012010120120101        N
G886000200410mg/day for 60 or greater consecutive days
G8861001003Central dual-energy x-ray absorptiometry (dxa) ordered or documented, review of DXA ordered for osteo       00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8861002004systems and medication history or pharmacologic therapy (other than
G8861003004minerals/vitamins) for osteoporosis prescribed
G8862001003Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 No corticostrd 10mg 60 days 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8862002004or greater consecutive days
G8863001003Patients not assessed for risk of bone loss, reason not given                   No assess bone loss         00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8864001003Pneumococcal vaccine administered or previously received                        Pneumococcal vaccine admin  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8865001003Documentation of medical reason(s) for not administering or previously          Doc med reas no pneumococcal00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8865002004receiving pneumococcal vaccine (e. G. , patient allergic reaction, potential
G8865003004adverse drug reaction)
G8866001003Documentation of patient reason(s) for not administering or previously          Doc pt reas no pneumococcal 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8866002004receiving pneumococcal vaccine (e. G. , patient refusal)
G8867001003Pneumococcal vaccine not administered or previously received, reason not given  No pneumococcal admin       00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8868001003Patients receiving a first course of anti-tnf therapy                           1st course antiTNF          00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8869001003Patient has documented immunity to hepatitis b and is receiving a first course  Doc immun hep B 1st antiTNF 00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8869002004of anti-tnf therapy
G8870001003Hepatitis b vaccine injection administered or previously received and is        HepB admin 1st antiTNF      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8870002004receiving a first course of anti-tnf therapy
G8871001003Patient not receiving a first course of anti-tnf therapy                        No 1st antiTNF              00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8872001003Excised tissue evaluated by imaging intraoperatively to confirm successful      Intraop image confirm excise00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8872002004inclusion of targeted lesion
G8873001003Patients with needle localization specimens which are not amenable to           Specimen not intraop image  00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8873002004intraoperative imaging such as mri needle wire localization, or targets which
G8873003004are tentatively identified on mammogram or ultrasound which do not contain a
G8873004004biopsy marker but which can be verified on intraoperative inspection or
G8873005004pathology (e. G. , needle biopsy site where the biopsy marker is remote from
G8873006004the actual biopsy site)
G8874001003Excised tissue not evaluated by imaging intraoperatively to confirm successful  Tissue not image intraop    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8874002004inclusion of targeted lesion
G8875001003Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy Breast cancer dx min invsive00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8875002004method
G8876001003Documentation of reason(s) for not performing minimally invasive biopsy to      Doc reas no min inv dx      00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8876002004diagnose breast cancer properatively (e. G. , clinical and imaging findings
G8876003004consistent with a benign lesion, lesion too close to skin, implant, chest wall,
G8876004004etc. , lesion could not be adequately visualized for needle biopsy, patient
G8876005004condition prevents needle biopsy [weight, breast thickness, etc. ], duct
G8876006004excision without imaging abnormality, prophylactic mastectomy, reduction
G8876007004mammoplasty, excisional biopsy performed by another physician
G8877001003Clinician did not attempt to achieve the diagnosis of breast cancer             No brst cncr dx min invasive00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8877002004preoperatively by a minimally invasive biopsy method, reason not given
G8878001003Sentinel lymph node biopsy procedure performed                                  Sent lymph node biopsy      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8879001003Clinically node negative (t1n0m0) or t2n0m0) invasive breast cancer             Node neg inv brst cncr      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8880001003Documentation of reason(s) sentinel lymph node biopsy not performed (e. G. ,    Doc reas no lymph node biop 00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8880002004cancer diagnosed at prophylactic mastectomy, non-invasive cancer, incidental
G8880003004discovery of breast cancer on prophylactic mastectomy, incidental discovery of
G8880004004breast cancer on reduction mammoplasty, biopsy proven lymph node (ln)
G8880005004metastases [e. G. , pre-op fna or core biopsy, inflammatory carcinoma,
G8880006004recurrent invasive breast cancer] patient refusal after informed consent)
G8881001003Stage of breast cancer is greater than t1n0m0 or t2n0m0                         Brst cncr stage > T1N0M0    00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8882001003Sentinel lymph node biopsy procedure not performed                              No sent lymph node biopsy   00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8883001003Biopsy results reviewed, communicated, tracked and documented                   Rev, comm, track, doc biopsy00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8884001003Clinician documented reason that patient's biopsy results were not reviewed     Doc reas biopsy not review  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8885001003Bipsy results not reviewed, communicated, tracked or documented                 No rev, comm, track biopsy  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8886001003Most recent blood pressure under control                                        BP under control            00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8887001003Documentation of medical reason(s) for most recent blood pressure not being     Doc med reas BP not control 00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8887002004under control (e. G. , patients who had a terminal illness or for whom
G8887003004treatment of hypertension with standard treatment goals is not clinically
G8887004004appropriate)
G8888001003Most recent blood pressure not under control, results documented and reviewed   BP not under control        00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8889001003No documentation of blood pressure measurement, reason not given                No doc BP                   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8890001003Most recent ldl-c under control, results documented and reviewed                LDL-C under control         00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8891001003Documentation of medical reason(s) for most recent ldl-c not under control (e.  Doc med reas no LDL-C contrl00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8891002004G. Patients who had a terminal illness or for whom treatment of hypertension
G8891003004with standard treatment goals is not clinically appropriate)
G8892001003Documentation of medical reason(s) for not performing ldl-c test (e. G.         Doc med reas no LDL-C test  00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8892002004Patients who had a terminal illness or for whom treatment of hypertension with
G8892003004standard treatment goals is not clinically appropriate)
G8893001003Most recent ldl-c not under control, results documented and reviewed            LDL-C not under control     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8894001003Ldl-c not performed, reason not given                                           LDL-C not performed         00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8895001003Oral aspirin or other antithrombotic therapy prescribed                         Antrom prescribe            00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8896001003Documentation of medical reason(s) for not prescribing oral aspirin or other    Doc med reas no antihtrom   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8896002004antthrombotic therapy (e. G. , patient documented to be low risk or patient
G8896003004with terminal illness or treatment of hypertension with standard treatment
G8896004004goals is not clinically appropriate, or for whom risk of aspirin or other
G8896005004antithrombotic therapy exceeds potential benefits such as for individuals whose
G8896006004blood pressure is poorly controlled)
G8897001003Oral aspirin or other antithrombotic therapy was not prescribed, reason not     Antithrom not prescribe     00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8897002004given
G8898001003I intend to report the chronic obstructive pulmonary disease (copd) measures    COPD Measures Group         00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8898002004group
G8899001003I intend to report the inflammatory bowel disease (ibd) measures group          Inflammatory Bowel Dis MG   00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8900001003I intend to report the sleep apnea measures group                               Obstructive Sleep Apnea MG  00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8901001003I intend to report the epilepsy measures group                                  Epilepsy Measures Group     00      9                                                                                                     C                          M5B 1      0201201012013010120121231D
G8902001003I intend to report the dementia measures group                                  Dementia Measures Group     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8903001003I intend to report the parkinson's disease measures group                       Parkinson's Disease MG      00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8904001003I intend to report the hypertension (htn) measures group                        Hypertension MG             00      9                                                                                                     C                          M5B 1      02012010120130101        C
G8905001003I intend to report the cardiovascular prevention measures group                 Cardiovascular Prevention MG00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8906001003I intend to report the cataract measures group                                  Cataract Measures Group     00      9                                                                                                     C                          M5B 1      02012010120120101        N
G8907001003Patient documented not to have experienced any of the following events: a burn  Pt doc no events on discharg00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8907002004prior to discharge; a fall within the facility; wrong
G8907003004site/side/patient/procedure/implant event; or a hospital transfer or hospital
G8907004004admission upon discharge from the facility
G8908001003Patient documented to have received a burn prior to discharge                   Pt doc w burn prior to D/C  00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8909001003Patient documented not to have received a burn prior to discharge               Pt doc no burn prior to D/C 00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8910001003Patient documented to have experienced a fall within asc                        Pt doc to have fall in ASC  00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8911001003Patient documented not to have experienced a fall within ambulatory surgical    Pt doc no fall in ASC       00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8911002004center
G8912001003Patient documented to have experienced a wrong site, wrong side, wrong patient, Pt doc with wrong event     00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8912002004wrong procedure or wrong implant event
G8913001003Patient documented not to have experienced a wrong site, wrong side, wrong      Pt doc no wrong event       00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8913002004patient, wrong procedure or wrong implant event
G8914001003Patient documented to have experienced a hospital transfer or hospital          Pt trans to hosp post D/C   00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8914002004admission upon discharge from asc
G8915001003Patient documented not to have experienced a hospital transfer or hospital      Pt not trans to hosp at D/C 00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8915002004admission upon discharge from asc
G8916001003Patient with preoperative order for iv antibiotic surgical site infection (ssi) Pt w IV AB given on time    00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8916002004prophylaxis, antibiotic initiated on time
G8917001003Patient with preoperative order for iv antibiotic surgical site infection (ssi) Pt w IV AB not given on time00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8917002004prophylaxis, antibiotic not initiated on time
G8918001003Patient without preoperative order for iv antibiotic surgical site infection    Pt w/o preop order IV AB pro00      9                                                                                                     C                          M5B 1      02012040120120401        A
G8918002004(ssi) prophylaxis
G8919001003Most recent systolic blood pressure < 140 mmhg                                  Mst rcnt sys bp <140mmg     00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8920001003Most recent systolic blood pressure >= 140 mmhg                                 Mst rcnt sys bp >=140mmhg   00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8921001003Most recent diastolic blood pressure < 90 mmhg                                  Mst rcnt dia bp <90mmhg     00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8922001003Most recent diastolic blood pressure >= 90 mmhg                                 Mst rcnt dia bp >=90mmhg    00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8923001003Left ventricular ejection fraction (lvef) < 40% or documentation of moderately  LVEF < 40% or lvsd          00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8923002004or severely depressed left ventricular systolic function
G8924001003Spirometry test results demonstrate fev1/fvc <60% with copd symptoms (e. G. ,   Spiro EV1/FVC <60% COPD sym 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8924002004dyspnea, cough/sputum, wheezing)
G8925001003Spirometry test results demonstrate fev1/fvc >=60% or patient does not have     Spiro>=60% or pt no COPD sym00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8925002004copd symptoms
G8926001003Spirometry test not performed or documented, reason not given                   Spiro no perf or doc        00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8927001003Adjuvant chemotherapy referred, prescribed or previously received for ajcc      Adj chem pres AJCC III      00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8927002004stage iii, colon cancer
G8928001003Adjuvant chemotherapy not prescribed or previously received, reason given       Adj chem not pres rsn spec  00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8929001003Adjuvant chemotherapy not prescribed or previously received, reason not given   Adj cmo not pres rsn not gvn00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8930001003Assessment of depression severity not documented, reason not given              Assess of dep @ initial eval00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8931001003Assessment of depression severity not documented, reason not given              Asses of dep not documented 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8932001003Suicide risk assessed at the initial evaluation                                 Suicd rsk assessed init eval00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8933001003Suicide risk not assessed at the initial evaluation, reason not given           Suicide risk not assessed   00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8934001003Left ventricular ejection fraction (lvef) <40% or documentation of moderately   LVEF <40% or dep lv sys fcn 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8934002004or severely depressed left ventricular systolic function
G8935001003Clinician prescribed angiotensin converting enzyme (ace) inhibitor or           Rx ACE or ARB therapy       00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8935002004angiotensin receptor blocker (arb) therapy
G8936001003Clinician documented that patient was not an eligible candidate for angiotensin Pt not eligible ACE/ARB     00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8936002004converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
G8937001003Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or    No rx ACE/ARB therapy       00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8937002004angiotensin receptor blocker (arb) therapy, reason not given
G8938001003Bmi is calculated, but patient not eligible for follow-up plan                  BMI calc, pt no f/u plan elg00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8939001003Pain assessment documented, follow-up plan not documented, patient not          Pain assess doc, f/u no doc 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8939002004eligible/appropriate
G8940001003Screening for clinical depression documented, follow-up plan not documented,    Srn clin dep doc no f/u pln 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8940002004patient not eligible/appropriate
G8941001003Elder maltreatment screen documented, patient not eligible for follow-up        No doc elder scrn, pt no el 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8942001003Documented functional outcomes assessment and care plan within the previous 30  Doc fcn/care plan w/30 days 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8942002004days
G8943001003Ldl-c result not present or not within 12 months prior                          LDLC not pres w/i 12 mo prir00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8944001003Ajcc melanoma cancer stage 0 through iic melanoma                               AJCC Mel cnr stg 0 - IIC    00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8945001003Aneurysm minor diameter <= 6 cm for men                                         Aneurysm <=6 cm for men     00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8946001003Minimally invasive biopsy method attempted but not diagnostic of breast cancer  MIBM but no dx of breast CA 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8946002004(e. G. , high risk lesion of breast such as atypical ductal hyperplasia,
G8946003004lobular neoplasia, atypical lobular carcinoma in situ, atypical columnar
G8946004004hyperplasica, flat epithelial atypia, radial scar, complex sclerosing lesion,
G8946005004papillary lesion, or any lesion with spindle cells)
G8947001003One or more neuropsychiatric symptoms                                           1 or more neuropsych        00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8948001003No neuropsychiatric symptoms                                                    No neuropsych symptoms      00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8949001003Documentation of patient reason(s) for patient not receiving counseling for     Doc pt reas on counsel diet 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8949002004diet and physical activity (e. G. , patient is not willing to discuss diet or
G8949003004exercise interventions to help control blood pressure, or the patient said
G8949004004he/she refused to make these changes)
G8950001003Pre-hypertensive or hypertensive blood pressure reading documented, indicated   Pre-htn or htn doc, f/u indc00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8950002004follow-up documented
G8951001003Pre-hypertensive or hypertensive blood pressure reading documented, indicated   Pre-htn/htn doc, no pt f/u  00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8951002004follow-up not documented, patient not eligible/not appropriate
G8952001003Pre-hypertensive or hypertensive blood pressure reading documented, indicated   Pre-htn/htn, no f/u, not gvn00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8952002004follow-up not documented, reason not given
G8953001003All quality actions for the applicable measures in the oncology measures group  Oncology MG qual act perform00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8953002004have been performed for this patient
G8954001003Complete and appropriate patient data were reported to a qualified clinical     Pt data rpt qual clin db reg00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8954002004database registry
G8955001003Most recent assessment of adequacy of volume management                         Most recent assess vol mgmt 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8956001003Patient receiving maintenance hemodialysis in an outpatient dialysis facility   Pt rcv HeDia outpt dyls fac 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8957001003Patient not receiving maintenance hemodialysis in an outpatient dialysis        Pt no HeDia in outpt fac    00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8957002004facility
G8958001003Assessment of adequacy of volume management not documented, reason not given    Assess vol mgmt not doc     00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8959001003Clinician treating major depressive disorder communicates to clinician treating Clin tx MDD comm to tx clin 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8959002004comorbid condition
G8960001003Clinician treating major depressive disorder did not communicate to clinician   Clin tx MDD not comm        00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8960002004treating comorbid condition, reason not given
G8961001003Cardiac stress imaging test primarily performed on low-risk surgery patient for CSIT lowrisk surg pts preop 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8961002004preoperative evaluation within 30 days preceding this surgery
G8962001003Cardiac stress imaging test performed on patient for any reason including those CSIT on pt any reas 30 days 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8962002004who did not have low risk surgery or test that was performed more than 30 days
G8962003004preceding low risk surgery
G8963001003Cardiac stress imaging performed primarily for monitoring of asymptomatic       CSI per asx pt w/PCI 2 yrs  00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8963002004patient who had pci within 2 years
G8964001003Cardiac stress imaging test performed primarily for any other reason than       CSI any other than PCI 2 yr 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8964002004monitoring of asymptomatic patient who had pci within 2 years (e.G. ,
G8964003004symptomatic patient, patient greater than 2 years since pci, initial
G8964004004evaluation, etc)
G8965001003Cardiac stress imaging test primarily performed on low chd risk patient for     CSIT perf on low CHD rsk    00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8965002004initial detection and risk assessment
G8966001003Cardiac stress imaging test performed on symptomatic or higher than low chd     CSIT perf sx or high CHD rsk00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8966002004risk patient or for any reason other than initial detection and risk assessment
G8967001003Warfarin or another oral anticoagulant that is fda approved prescribed          Wrfrn or oral antigoag pres 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8968001003Documentation of medical reason(s) for not prescribing warfarin or another oral Md rsn no pres Wrfrn or othr00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8968002004anticoagulant that is fda approved not prescribed (e. G. , allergy, risk of
G8968003004bleeding, transient or reversible causes of atrial fibrillation, other medical
G8968004004reasons including, but not limited to pregnancy, mitral stenosis, prosthetic
G8968005004heart valve or patient is in the postoperative period)
G8969001003Documentation of patient reason(s) for not prescribing warfarin or another oral Pt rsn no pres Wrfrn or othr00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8969002004anticoagulant that is fda approved (e. G. , economic, social, and/or religious
G8969003004impediments, noncompliance or patient refusal, other patient reasons)
G8970001003No risk factors or one moderate risk factor for thromboembolism                 No rsk fac or 1 mod risk TE 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8971001003Warfarin or another oral anticoagulant that is fda approved not prescribed,     Warfrn or othr antcog no rx 00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8971002004reason not given
G8972001003One or more high risk factors for thromboembolism or more than one moderate     1>=risk or>= mod risk for TE00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8972002004risk factor for thromboembolism
G8973001003Most recent hemoglobin (hgb) level < 10 g/dl                                    Mst rcnt Hbb < 10g/dL       00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8974001003Hemoglobin level measurement not documented, reason not given                   Hgb not doc rns not gvn     00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8975001003Documentation of medical reason(s) for patient having a hemoglobin level < 10   Hgb <10g/dL, med rsn        00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8975002004g/dl (e. G. , patients who have non-renal etiologies of anemia [e. G. , sickle
G8975003004cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow
G8975004004disease, anemia related to chemotherapy for diagnosis of malignancy,
G8975005004postoperative bleeding, active bloodstream or peritoneal infection], other
G8975006004medical reasons)
G8976001003Most recent hemoglobin (hgb) level >= 10 g/dl                                   Hgb >= 10 g/dL              00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8977001003I intend to report the oncology measures group                                  Oncology measures grp       00      9                                                                                                     C                          M5B 1      02013010120130101        A
G8978001003Mobility: walking & moving around functional limitation, current status, at     Mobility current status     00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8978002004therapy episode outset and at reporting intervals
G8979001003Mobility: walking & moving around functional limitation, projected goal status, Mobility goal status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8979002004at therapy episode outset, at reporting intervals, and at discharge or to end
G8979003004reporting
G8980001003Mobility: walking & moving around functional limitation, discharge status, at   Mobility D/C status         00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8980002004discharge from therapy or to end reporting
G8981001003Changing & maintaining body position functional limitation, current status, at  Body pos current status     00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8981002004therapy episode outset and at reporting intervals
G8982001003Changing & maintaining body position functional limitation, projected goal      Body pos goal status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8982002004status, at therapy episode outset, at reporting intervals, and at discharge or
G8982003004to end reporting
G8983001003Changing & maintaining body position functional limitation, discharge status,   Body pos D/C status         00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8983002004at discharge from therapy or to end reporting
G8984001003Carrying, moving & handling objects functional limitation, current status, at   Carry current status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8984002004therapy episode outset and at reporting intervals
G8985001003Carrying, moving & handling objects functional limitation, current status, at   Carry goal status           00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8985002004therapy episode outset and at reporting intervals
G8986001003Carrying, moving & handling objects functional limitation, discharge status, at Carry D/C status            00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8986002004discharge from therapy or to end reporting
G8987001003Self care functional limitation, current status, at therapy episode outset and  Self care current status    00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8987002004at reporting intervals
G8988001003Self care functional limitation, projected goal status, at therapy episode      Self care goal status       00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8988002004outset, at reporting intervals, and at discharge or to end reporting
G8989001003Self care functional limitation, discharge status, at discharge from therapy or Self care D/C status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8989002004to end reporting
G8990001003Other physical or occupational primary functional limitation, current status,   Other PT/OT current status  00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8990002004at therapy episode outset and at reporting intervals
G8991001003Other physical or occupational primary functional limitation, projected goal    Other PT/OT goal status     00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8991002004status, at therapy episode outset, at reporting intervals, and at discharge or
G8991003004to end reporting
G8992001003Other physical or occupational primary functional limitation, discharge status, Other PT/OT  D/C status     00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8992002004at discharge from therapy or to end reporting
G8993001003Other physical or occupational subsequent functional limitation, current        Sub PT/OT current status    00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8993002004status, at therapy episode outset and at reporting intervals
G8994001003Other physical or occupational subsequent functional limitation, projected goal Sub PT/OT goal status       00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8994002004status, at therapy episode outset, at reporting intervals, and at discharge or
G8994003004to end reporting
G8995001003Other physical or occupational subsequent functional limitation, discharge      Sub PT/OT D/C status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8995002004status, at discharge from therapy or to end reporting
G8996001003Swallowing functional limitation, current status at time of initial therapy     Swallow current status      00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8996002004treatment/episode outset and reporting intervals
G8997001003Swallowing functional limitation, projected goal status, at initial therapy     Swallow goal status         00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8997002004treatment/outset and at discharge from therapy
G8998001003Swallowing functional limitation, discharge status, at discharge from           Swallow D/C status          00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8998002004therapy/end of reporting on limitation
G8999001003Motor speech functional limitation, current status at time of initial therapy   Motor speech current status 00      9                                                                                                     C                          M5D 1      02013010120130101        A
G8999002004treatment/episode outset and reporting intervals
G9001001003Coordinated care fee, initial rate                                              MCCD, initial rate          00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9002001003Coordinated care fee, maintenance rate                                          MCCD,maintenance rate       00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9003001003Coordinated care fee, risk adjusted high, initial                               MCCD, risk adj hi, initial  00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9004001003Coordinated care fee, risk adjusted low, initial                                MCCD, risk adj lo, initial  00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9005001003Coordinated care fee, risk adjusted maintenance                                 MCCD, risk adj, maintenance 00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9006001003Coordinated care fee, home monitoring                                           MCCD, Home monitoring       00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9007001003Coordinated care fee, scheduled team conference                                 MCCD, sch team conf         00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9008001003Coordinated care fee, physician coordinated care oversight services             Mccd,phys coor-care ovrsght 00      9                                                                                                     D                      0097Y2  1      02000100120001001        N
G9009001003Coordinated care fee, risk adjusted maintenance, level 3                        MCCD, risk adj, level 3     00      9                                                                                                     D                      0096Y2  1      02001100120011001        N
G9010001003Coordinated care fee, risk adjusted maintenance, level 4                        MCCD, risk adj, level 4     00      9                                                                                                     D                      0096Y2  1      02001100120011001        N
G9011001003Coordinated care fee, risk adjusted maintenance, level 5                        MCCD, risk adj, level 5     00      9                                                                                                     D                      0096Y2  1      02001100120011001        N
G9012001003Other specified case management service not elsewhere classified                Other Specified Case Mgmt   00      9                                                                                                     D                      0096Y2  1      02001100120011001        N
G9013001003Esrd demo basic bundle level i                                                  ESRD demo bundle level I    00      9                                                                                                     M                      0096Y2  1      02004070120040701        N
G9014001003Esrd demo expanded bundle including venous access and related services          ESRD demo bundle-level II   00      9                                                                                                     M                      0096Y2  1      02004070120040701        N
G9016001003Smoking cessation counseling, individual, in the absence of or in addition to   Demo-smoking cessation coun 00      9                                                                                                     M                      0096Y2  1      02001010120010101        N
G9016002004any other evaluation and management service, per session (6-10 minutes) [demo
G9016003004project code only]
G9017001003Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved      Amantadine HCL 100mg oral   13      A                                                                                                     C                          O1E 1      02004120120041201        N
G9017002004demonstration project)
G9018001003Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use  Zanamivir,inhalation pwd 10m13      A                                                                                                     C                          O1E 1      02004120120041201        N
G9018002004in a medicare-approved demonstration project)
G9019001003Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved          Oseltamivir phosphate 75mg  13      A                                                                                                     C                          O1E 1      02004120120041201        N
G9019002004demonstration project)
G9020001003Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved     Rimantadine HCL 100mg oral  13      A                                                                                                     C                          O1E 1      02004120120041201        N
G9020002004demonstration project)
G9033001003Amantadine hydrochloride, oral brand, per 100 mg (for use in a                  Amantadine HCL oral brand   13      A                                                                                                     C                          O1E 1      02004120120041201        N
G9033002004medicare-approved demonstration project)
G9034001003Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg    Zanamivir, inh pwdr, brand  00      9                                                                                                     C                          O1E 1      02004120120041201        N
G9034002004(for use in a medicare-approved demonstration project)
G9035001003Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved   Oseltamivir phosp, brand    00      9                                                                                                     C                          O1E 1      02004120120041201        N
G9035002004demonstration project)
G9036001003Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a                Rimantadine HCL, brand      00      9                                                                                                     C                          O1E 1      02004120120041201        N
G9036002004medicare-approved demonstration project)
G9041001003Rehabilitation services for low vision by qualified occupational therapist,     Low vision rehab occupationa00      9                                                                                                     C                          T2D 1      0200601012012010120111231N
G9041002004direct one-on-one contact, each 15 minutes
G9042001003Rehabilitation services for low vision by certified orientation and mobility    Low vision rehab orient/mobi00      9                                                                                                     C                          T2D 1      0200601012012010120111231N
G9042002004specialists, direct one-on-one contact, each 15 minutes
G9043001003Rehabilitation services for low vision by certified low vision rehabilitation   Low vision lowvision therapi00      9                                                                                                     C                          T2D 1      0200601012012010120111231N
G9043002004therapist, direct one-on-one contact, each 15 minutes
G9044001003Rehabilitation services for low vision by certified low vision rehabilitation   Low vision rehabilate teache00      9                                                                                                     C                          T2D 1      0200601012012010120111231N
G9044002004teacher, direct one-on-one contact, each 15 minutes
G9050001003Oncology; primary focus of visit; work-up, evaluation, or staging at the time   Oncology work-up evaluation 00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9050002004of cancer diagnosis or recurrence (for use in a medicare-approved demonstration
G9050003004project)
G9051001003Oncology; primary focus of visit; treatment decision-making after disease is    Oncology tx decision-mgmt   00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9051002004staged or restaged, discussion of treatment options, supervising/coordinating
G9051003004active cancer directed therapy or managing consequences of cancer directed
G9051004004therapy (for use in a medicare-approved demonstration project)
G9052001003Oncology; primary focus of visit; surveillance for disease recurrence for       Onc surveillance for disease00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9052002004patient who has completed definitive cancer-directed therapy and currently
G9052003004lacks evidence of recurrent disease; cancer directed therapy might be
G9052004004considered in the future (for use in a medicare-approved demonstration project)
G9053001003Oncology; primary focus of visit; expectant management of patient with evidence Onc expectant management pt 00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9053002004of cancer for whom no cancer directed therapy is being administered or arranged
G9053003004at present; cancer directed therapy might be considered in the future (for use
G9053004004in a medicare-approved demonstration project)
G9054001003Oncology; primary focus of visit; supervising, coordinating or managing care of Onc supervision palliative  00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9054002004patient with terminal cancer or for whom other medical illness prevents further
G9054003004cancer treatment; includes symptom management, end-of-life care planning,
G9054004004management of palliative therapies (for use in a medicare-approved
G9054005004demonstration project)
G9055001003Oncology; primary focus of visit; other, unspecified service not otherwise      Onc visit unspecified NOS   00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9055002004listed (for use in a medicare-approved demonstration project)
G9056001003Oncology; practice guidelines; management adheres to guidelines (for use in a   Onc prac mgmt adheres guide 00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9056002004medicare-approved demonstration project)
G9057001003Oncology; practice guidelines; management differs from guidelines as a result   Onc pract mgmt differs trial00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9057002004of patient enrollment in an institutional review board approved clinical trial
G9057003004(for use in a medicare-approved demonstration project)
G9058001003Oncology; practice guidelines; management differs from guidelines because the   Onc prac mgmt disagree w/gui00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9058002004treating physician disagrees with guideline recommendations (for use in a
G9058003004medicare-approved demonstration project)
G9059001003Oncology; practice guidelines; management differs from guidelines because the   Onc prac mgmt pt opt alterna00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9059002004patient, after being offered treatment consistent with guidelines, has opted
G9059003004for alternative treatment or management, including no treatment (for use in a
G9059004004medicare-approved demonstration project)
G9060001003Oncology; practice guidelines; management differs from guidelines for reason(s) Onc prac mgmt dif pt comorb 00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9060002004associated with patient comorbid illness or performance status not factored
G9060003004into guidelines (for use in a medicare-approved demonstration project)
G9061001003Oncology; practice guidelines; patient's condition not addressed by available   Onc prac cond noadd by guide00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9061002004guidelines (for use in a medicare-approved demonstration project)
G9062001003Oncology; practice guidelines; management differs from guidelines for other     Onc prac guide differs nos  00      9                                                                                                     I                          P7B 1      02006010120070101        N
G9062002004reason(s) not listed (for use in a medicare-approved demonstration project)
G9063001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc stgI no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9063002004disease initially established as stage i (prior to neo-adjuvant therapy, if
G9063003004any) with no evidence of disease progression, recurrence, or metastases (for
G9063004004use in a medicare-approved demonstration project)
G9064001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc stg2 no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9064002004disease initially established as stage ii (prior to neo-adjuvant therapy, if
G9064003004any) with no evidence of disease progression, recurrence, or metastases (for
G9064004004use in a medicare-approved demonstration project)
G9065001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc stg3A no progre00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9065002004disease initially established as stage iii a (prior to neo-adjuvant therapy, if
G9065003004any) with no evidence of disease progression, recurrence, or metastases (for
G9065004004use in a medicare-approved demonstration project)
G9066001003Oncology; disease status; limited to non-small cell lung cancer; stage iii b-   Onc dx nsclc stg3B-4 metasta00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9066002004iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a
G9066003004medicare-approved demonstration project)
G9067001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc dx unknown nos 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9067002004disease unknown, staging in progress, or not listed (for use in a
G9067003004medicare-approved demonstration project)
G9068001003Oncology; disease status; limited to small cell and combined small              Onc dx sclc/nsclc limited   00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9068002004cell/non-small cell; extent of disease initially established as limited with no
G9068003004evidence of disease progression, recurrence, or metastases (for use in a
G9068004004medicare-approved demonstration project)
G9069001003Oncology; disease status; small cell lung cancer, limited to small cell and     Onc dx sclc/nsclc ext at dx 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9069002004combined small cell/non-small cell; extensive stage at diagnosis, metastatic,
G9069003004locally recurrent, or progressive (for use in a medicare-approved demonstration
G9069004004project)
G9070001003Oncology; disease status; small cell lung cancer, limited to small cell and     Onc dx sclc/nsclc ext unknwn00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9070002004combined small cell/non-small; extent of disease unknown, staging in progress,
G9070003004or not listed (for use in a medicare-approved demonstration project)
G9071001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg1-2B HR,nopro00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9071002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or
G9071003004stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of
G9071004004disease progression, recurrence, or metastases (for use in a medicare-approved
G9071005004demonstration project)
G9072001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg1-2 noprogres00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9072002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or
G9072003004stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of
G9072004004disease progression, recurrence, or metastases (for use in a medicare-approved
G9072005004demonstration project)
G9073001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg3-HR, no pro 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9073002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage
G9073003004iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of
G9073004004disease progression, recurrence, or metastases (for use in a medicare-approved
G9073005004demonstration project)
G9074001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg3-noprogress 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9074002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage
G9074003004iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of
G9074004004disease progression, recurrence, or metastases (for use in a medicare-approved
G9074005004demonstration project)
G9075001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst metastic/ recur 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9075002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at
G9075003004diagnosis, metastatic, locally recurrent, or progressive (for use in a
G9075004004medicare-approved demonstration project)
G9077001003Oncology; disease status; prostate cancer, limited to adenocarcinoma as         Onc dx prostate T1no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9077002004predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at
G9077003004diagnosis with no evidence of disease progression, recurrence, or metastases
G9077004004(for use in a medicare-approved demonstration project)
G9078001003Oncology; disease status; prostate cancer, limited to adenocarcinoma as         Onc dx prostate T2no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9078002004predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no
G9078003004evidence of disease progression, recurrence, or metastases (for use in a
G9078004004medicare-approved demonstration project)
G9079001003Oncology; disease status; prostate cancer, limited to adenocarcinoma as         Onc dx prostate T3b-T4noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9079002004predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence
G9079003004of disease progression, recurrence, or metastases (for use in a
G9079004004medicare-approved demonstration project)
G9080001003Oncology; disease status; prostate cancer, limited to adenocarcinoma; after     Onc dx prostate w/rise PSA  00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9080002004initial treatment with rising psa or failure of psa decline (for use in a
G9080003004medicare-approved demonstration project)
G9083001003Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of Onc dx prostate unknwn nos  00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9083002004disease unknown, staging in progress, or not listed (for use in a
G9083003004medicare-approved demonstration project)
G9084001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon t1-3,n1-2,no pr00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9084002004adenocarcinoma as predominant cell type; extent of disease initially
G9084003004established as t1-3, n0, m0 with no evidence of disease progression,
G9084004004recurrence, or metastases (for use in a medicare-approved demonstration project)
G9085001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon T4, N0 w/o prog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9085002004adenocarcinoma as predominant cell type; extent of disease initially
G9085003004established as t4, n0, m0 with no evidence of disease progression, recurrence,
G9085004004or metastases (for use in a medicare-approved demonstration project)
G9086001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon T1-4 no dx prog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9086002004adenocarcinoma as predominant cell type; extent of disease initially
G9086003004established as t1-4, n1-2, m0 with no evidence of disease progression,
G9086004004recurrence, or metastases (for use in a medicare-approved demonstration project)
G9087001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon metas evid dx  00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9087002004adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally
G9087003004recurrent, or progressive with current clinical, radiologic, or biochemical
G9087004004evidence of disease (for use in a medicare-approved demonstration project)
G9088001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon metas noevid dx00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9088002004adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally
G9088003004recurrent, or progressive without current clinical, radiologic, or biochemical
G9088004004evidence of disease (for use in a medicare-approved demonstration project)
G9089001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon extent unknown 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9089002004adenocarcinoma as predominant cell type; extent of disease unknown, staging in
G9089003004progress, or not listed (for use in a medicare-approved demonstration project)
G9090001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal T1-2 no progr 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9090002004adenocarcinoma as predominant cell type; extent of disease initially
G9090003004established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no
G9090004004evidence of disease progression, recurrence, or metastases (for use in a
G9090005004medicare-approved demonstration project)
G9091001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal T3 N0 no prog 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9091002004adenocarcinoma as predominant cell type; extent of disease initially
G9091003004established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no
G9091004004evidence of disease progression, recurrence, or metastases (for use in a
G9091005004medicare-approved demonstration project)
G9092001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal T1-3,N1-2noprg00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9092002004adenocarcinoma as predominant cell type; extent of disease initially
G9092003004established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no
G9092004004evidence of disease progression, recurrence or metastases (for use in a
G9092005004medicare-approved demonstration project)
G9093001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal T4,N,M0 no prg00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9093002004adenocarcinoma as predominant cell type; extent of disease initially
G9093003004established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no
G9093004004evidence of disease progression, recurrence, or metastases (for use in a
G9093005004medicare-approved demonstration project)
G9094001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal M1 w/mets prog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9094002004adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally
G9094003004recurrent, or progressive (for use in a medicare-approved demonstration project)
G9095001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal extent unknwn 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9095002004adenocarcinoma as predominant cell type; extent of disease unknown, staging in
G9095003004progress, or not listed (for use in a medicare-approved demonstration project)
G9096001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophag T1-T3 noprog 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9096002004squamous cell carcinoma as predominant cell type; extent of disease initially
G9096003004established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with
G9096004004no evidence of disease progression, recurrence, or metastases (for use in a
G9096005004medicare-approved demonstration project)
G9097001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophageal T4 no prog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9097002004squamous  cell carcinoma as predominant cell type; extent of disease initially
G9097003004established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no
G9097004004evidence of disease progression, recurrence, or metastases (for use in a
G9097005004medicare-approved demonstration project)
G9098001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophageal mets recur00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9098002004squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic,
G9098003004locally recurrent, or progressive (for use in a medicare-approved demonstration
G9098004004project)
G9099001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophageal unknown   00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9099002004squamous cell carcinoma as predominant cell type; extent of disease unknown,
G9099003004staging in progress, or not listed (for use in a medicare-approved
G9099004004demonstration project)
G9100001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric no recurrence00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9100002004predominant cell type; post r0 resection (with or without neoadjuvant therapy)
G9100003004with no evidence of disease recurrence, progression, or metastases (for use in
G9100004004a medicare-approved demonstration project)
G9101001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric p R1-R2noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9101002004predominant cell type; post r1 or r2 resection (with or without neoadjuvant
G9101003004therapy) with no evidence of disease progression, or metastases (for use in a
G9101004004medicare-approved demonstration project)
G9102001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric unresectable 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9102002004predominant cell type; clinical or pathologic m0, unresectable with no evidence
G9102003004of disease progression, or metastases (for use in a medicare-approved
G9102004004demonstration project)
G9103001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric recurrent    00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9103002004predominant cell type; clinical or pathologic m1 at diagnosis, metastatic,
G9103003004locally recurrent, or progressive (for use in a medicare-approved demonstration
G9103004004project)
G9104001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric unknown NOS  00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9104002004predominant cell type; extent of disease unknown, staging in progress, or not
G9104003004listed (for use in a medicare-approved demonstration project)
G9105001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as       Onc dx pancreatc p R0 res no00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9105002004predominant cell type; post r0 resection without evidence of disease
G9105003004progression, recurrence, or metastases (for use in a medicare-approved
G9105004004demonstration project)
G9106001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 Onc dx pancreatc p R1/R2 no 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9106002004or r2 resection with no evidence of disease progression, or metastases (for use
G9106003004in a medicare-approved demonstration project)
G9107001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma;         Onc dx pancreatic unresectab00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9107002004unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or
G9107003004progressive (for use in a medicare-approved demonstration project)
G9108001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent  Onc dx pancreatic unknwn NOS00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9108002004of disease unknown, staging in progress, or not listed (for use in a
G9108003004medicare-approved demonstration project)
G9109001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck T1-T2no prg00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9109002004cavity, pharynx and larynx with squamous cell as predominant cell type; extent
G9109003004of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant
G9109004004therapy, if any) with no evidence of disease progression, recurrence, or
G9109005004metastases (for use in a medicare-approved demonstration project)
G9110001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck T3-4 noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9110002004cavity, pharynx and larynx with squamous cell as predominant cell type; extent
G9110003004of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant
G9110004004therapy, if any) with no evidence of disease progression, recurrence, or
G9110005004metastases (for use in a medicare-approved demonstration project)
G9111001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck M1 mets rec00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9111002004cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at
G9111003004diagnosis, metastatic, locally recurrent, or progressive (for use in a
G9111004004medicare-approved demonstration project)
G9112001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck ext unknown00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9112002004cavity, pharynx and larynx with squamous cell as predominant cell type; extent
G9112003004of disease unknown, staging in progress, or not listed (for use in a
G9112004004medicare-approved demonstration project)
G9113001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian stg1A-B no pr00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9113002004pathologic stage ia-b (grade 1) without evidence of disease progression,
G9113003004recurrence, or metastases (for use in a medicare-approved demonstration project)
G9114001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian stg1A-B or 2 00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9114002004pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii;
G9114003004without evidence of disease progression, recurrence, or metastases (for use in
G9114004004a medicare-approved demonstration project)
G9115001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian stg3/4 noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9115002004pathologic stage iii-iv; without evidence of progression, recurrence, or
G9115003004metastases (for use in a medicare-approved demonstration project)
G9116001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian recurrence   00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9116002004evidence of disease progression, or recurrence, and/or platinum resistance (for
G9116003004use in a medicare-approved demonstration project)
G9117001003Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent  Onc dx ovarian unknown NOS  00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9117002004of disease unknown, staging in progress, or not listed (for use in a
G9117003004medicare-approved demonstration  project)
G9123001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx CML chronic phase    00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9123002004chromosome positive and/or bcr-abl positive; chronic phase not in hematologic,
G9123003004cytogenetic, or molecular remission (for use in a medicare-approved
G9123004004demonstration project)
G9124001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx CML acceler phase    00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9124002004chromosome positive and/or bcr-abl positive; accelerated phase not in
G9124003004hematologic cytogenetic, or molecular remission (for use in a medicare-approved
G9124004004demonstration project)
G9125001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx CML blast phase      00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9125002004chromosome positive and/or bcr-abl positive; blast phase not in hematologic,
G9125003004cytogenetic, or molecular remission (for use in a medicare-approved
G9125004004demonstration project)
G9126001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx CML remission        00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9126002004chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or
G9126003004molecular remission (for use in a medicare-approved demonstration project)
G9128001003Oncology; disease status; limited to multiple myeloma, systemic disease;        Onc dx multi myeloma stage I00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9128002004smoldering, stage i (for use in a medicare-approved demonstration project)
G9129001003Oncology; disease status; limited to multiple myeloma, systemic disease; stage  Onc dx mult myeloma stg2 hig00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9129002004ii or higher (for use in a medicare-approved demonstration project)
G9130001003Oncology; disease status; limited to multiple myeloma, systemic disease; extent Onc dx multi myeloma unknown00      9                                                                                                     C                          P7B 1      02006010120070101        N
G9130002004of disease unknown, staging in progress, or not listed (for use in a
G9130003004medicare-approved demonstration project)
G9131001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst unknown NOS     00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9131002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of
G9131003004disease unknown, staging in progress, or not listed (for use in a
G9131004004medicare-approved demonstration project)
G9132001003Oncology; disease status; prostate cancer, limited to adenocarcinoma;           Onc dx prostate mets no cast00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9132002004hormone-refractory/androgen-independent (e. G. , rising psa on anti-androgen
G9132003004therapy or post-orchiectomy); clinical metastases (for use in a
G9132004004medicare-approved demonstration project)
G9133001003Oncology; disease status; prostate cancer, limited to adenocarcinoma;           Onc dx prostate clinical met00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9133002004hormone-responsive; clinical metastases or m1 at diagnosis (for use in a
G9133003004medicare-approved demonstration project)
G9134001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc NHLstg 1-2 no relap no  00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9134002004stage i, ii at diagnosis, not relapsed, not refractory (for use in a
G9134003004medicare-approved demonstration project)
G9135001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc dx NHL stg 3-4 not relap00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9135002004stage iii, iv, not relapsed, not refractory (for use in a medicare-approved
G9135003004demonstration project)
G9136001003Oncology; disease status; non-hodgkin's lymphoma, transformed from original     Onc dx NHL trans to lg Bcell00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9136002004cellular diagnosis to a second cellular classification (for use in a
G9136003004medicare-approved demonstration project)
G9137001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc dx NHL relapse/refractor00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9137002004relapsed/refractory (for use in a medicare-approved demonstration project)
G9138001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc dx NHL stg unknown      00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9138002004diagnostic evaluation, stage not determined, evaluation of possible relapse or
G9138003004non-response to therapy, or not listed (for use in a medicare-approved
G9138004004demonstration project)
G9139001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx CML dx status unknown00      9                                                                                                     C                          P7B 1      02007010120070101        N
G9139002004chromosome positive and/or bcr-abl positive; extent of disease unknown, staging
G9139003004in progress, not listed (for use in a medicare-approved demonstration project)
G9140001003Frontier extended stay clinic demonstration; for a patient stay in a clinic     Frontier extended stay demo 00      9                                                                                                     C                          Z2  1      02007100120071001        N
G9140002004approved for the cms demonstration project; the following measures should be
G9140003004present: the stay must be equal to or greater than 4 hours; weather or other
G9140004004conditions must prevent transfer or the case falls into a category of
G9140005004monitoring and observation cases that are permitted by the rules of the
G9140006004demonstration; there is a maximum frontier extended stay clinic (fesc) visit of
G914000700448 hours, except in the case when weather or other conditions prevent transfer;
G9140008004payment is made on each period up to 4 hours, after the first 4 hours
G9141001003Influenza a (h1n1) immunization administration (includes the physician          Influenza A H1N1,admin w cou13      A                                                                                                     C                          O1G V      0200909012013010120121231D
G9141002004counseling the patient/family)
G9142001003Influenza a (h1n1) vaccine, any route of administration                         Influenza A H1N1, vaccine   13      A                                                                                                     C                          O1G V      0200909012013010120121231D
G9143001003Warfarin responsiveness testing by genetic technique using any method, any      Warfarin respon genetic test13      A                                                    220400                                           C                          M5D 1      02009080320130101        F
G9143002004number of specimen(s)
G9147001003Outpatient intravenous insulin treatment (oivit) either pulsatile or            Outpt IV insulin tx any mea 00      9                                                                                                     M                      0172P5E 9      02009122320091223        N
G9147002004continuous, by any means, guided by the results of measurements for:
G9147003004respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial,
G9147004004venous or capillary glucose; and/or potassium concentration
G9148001003National committee for quality assurance - level i medical home                 Medical Home Level I        00      9                                                                                                     C                          Z2  1      02011070120110701        A
G9149001003National committee for quality assurance - level 2 medical home                 Medical Home Level II       00      9                                                                                                     C                          Z2  1      02011070120110701        A
G9150001003National committee for quality assurance - level 3 medical home                 Medical Home Level III      00      9                                                                                                     C                          Z2  1      02011070120110701        A
G9151001003Mapcp demonstration - state provided services                                   MAPCP demo state            00      9                                                                                                     C                          Z2  1      02011070120110701        A
G9152001003Mapcp demonstration - community health teams                                    MAPCP demo community        00      9                                                                                                     C                          Z2  1      02011070120110701        A
G9153001003Mapcp demonstration - physician incentive pool                                  MAPCP demo physician        00      9                                                                                                     C                          Z2  1      02011070120110701        A
G9156001003Evaluation for wheelchair requiring face to face visit with physician           Evaluation for wheelchair   00      9                                                                                                     C                          Z2  1      02012010120120101        N
G9157001003Transesophageal doppler use for cardiac monitoring                              Transesoph doppl cardiac mon00      9                                                                                                     C                          T2C 1      02013100120131001        A
G9158001003Motor speech functional limitation, discharge status at discharge from          Motor speech D/C status     00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9158002004therapy/end of reporting on limitation
G9159001003Spoken language comprehension functional limitation, current status at time of  Lang comp current status    00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9159002004initial therapy treatment/episode outset and reporting intervals
G9160001003Spoken language comprehension functional limitation, projected goal status at   Lang comp goal status       00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9160002004initial therapy treatment/outset and at discharge from therapy
G9161001003Spoken language comprehension functional limitation, discharge status at        Lang comp D/C status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9161002004discharge from therapy/end of reporting on limitation
G9162001003Spoken language expression functional limitation, current status at time of     Lang express current status 00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9162002004initial therapy treatment/episode outset and reporting intervals
G9163001003Spoken language expression functional limitation, projected goal status at      Lang express goal status    00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9163002004initial therapy treatment/outset and at discharge from therapy
G9164001003Spoken language expression functional limitation, discharge status at discharge Lang express D/C status     00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9164002004from therapy/end of reporting on limitation
G9165001003Attention functional limitation, current status at time of initial therapy      Atten current status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9165002004treatment/episode outset and reporting intervals
G9166001003Attention functional limitation, projected goal status at initial therapy       Atten goal status           00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9166002004treatment/outset and at discharge from therapy
G9167001003Attention functional limitation, discharge status at discharge from therapy/end Atten D/C status            00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9167002004of reporting on limitation
G9168001003Memory functional limitation, current status at time of initial therapy         Memory current status       00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9168002004treatment/episode outset and reporting intervals
G9169001003Memory functional limitation, projected goal status at initial therapy          Memory goal status          00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9169002004treatment/outset and at discharge from therapy
G9170001003Memory functional limitation, discharge status at discharge from therapy/end of Memory D/C status           00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9170002004reporting on limitation
G9171001003Voice functional limitation, current status at time of initial therapy          Voice current status        00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9171002004treatment/episode outset and reporting intervals
G9172001003Voice functional limitation, projected goal status at initial therapy           Voice goal status           00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9172002004treatment/outset and at discharge from therapy
G9173001003Voice functional limitation, discharge status at discharge from therapy/end of  Voice D/C status            00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9173002004reporting on limitation
G9174001003Other speech language pathology functional limitation, current status at time   Speech lang current status  00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9174002004of initial therapy treatment/episode outset and reporting intervals
G9175001003Other speech language pathology functional limitation, projected goal status at Speech lang goal status     00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9175002004initial therapy treatment/outset and at discharge from therapy
G9176001003Other speech language pathology functional limitation, discharge status at      Speech lang D/C status      00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9176002004discharge from therapy/end of reporting on limitation
G9186001003Motor speech functional limitation, projected goal status at initial therapy    Motor speech goal status    00      9                                                                                                     C                          M5D 1      02013010120130101        A
G9186002004treatment/outset and at discharge from therapy
H0001002003Alcohol and/or drug assessment                                                  Alcohol and/or drug assess  00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0002001003Behavioral health screening to determine eligibility for admission to treatment Alcohol and/or drug screenin00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0002002004program
H0003001003Alcohol and/or drug screening; laboratory analysis of specimens for presence of Alcohol and/or drug screenin00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0003002004alcohol and/or drugs
H0004001003Behavioral health counseling and therapy, per 15 minutes                        Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0005001003Alcohol and/or drug services; group counseling by a clinician                   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0006001003Alcohol and/or drug services; case management                                   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0007001003Alcohol and/or drug services; crisis intervention (outpatient)                  Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0008001003Alcohol and/or drug services; sub-acute detoxification (hospital inpatient)     Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0009001003Alcohol and/or drug services; acute detoxification (hospital inpatient)         Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0010001003Alcohol and/or drug services; sub-acute detoxification (residential addiction   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0010002004program inpatient)
H0011001003Alcohol and/or drug services; acute detoxification (residential addiction       Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0011002004program inpatient)
H0012001003Alcohol and/or drug services; sub-acute detoxification (residential addiction   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0012002004program outpatient)
H0013001003Alcohol and/or drug services; acute detoxification (residential addiction       Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0013002004program outpatient)
H0014001003Alcohol and/or drug services; ambulatory detoxification                         Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0015001003Alcohol and/or drug services; intensive outpatient (treatment program that      Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0015002004operates at least 3 hours/day and at least 3 days/week and is based on an
H0015003004individualized treatment plan), including assessment, counseling; crisis
H0015004004intervention, and activity therapies or education
H0016001003Alcohol and/or drug services; medical/somatic (medical intervention in          Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0016002004ambulatory setting)
H0017001003Behavioral health; residential (hospital residential treatment program),        Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0017002004without room and board, per diem
H0018001003Behavioral health; short-term residential (non-hospital residential treatment   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0018002004program), without room and board, per diem
H0019001003Behavioral health; long-term residential (non-medical, non-acute care in a      Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0019002004residential treatment program where stay is typically longer than 30 days),
H0019003004without room and board, per diem
H0020001003Alcohol and/or drug services; methadone administration and/or service           Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0020002004(provision of the drug by a licensed program)
H0021001003Alcohol and/or drug training service (for staff and personnel not employed by   Alcohol and/or drug training00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0021002004providers)
H0022001003Alcohol and/or drug intervention service (planned facilitation)                 Alcohol and/or drug interven00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0023001003Behavioral health outreach service (planned approach to reach a targeted        Alcohol and/or drug outreach00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0023002004population)
H0024001003Behavioral health prevention information dissemination service (one-way direct  Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0024002004or non-direct contact with service audiences to affect knowledge and attitude)
H0025001003Behavioral health prevention education service (delivery of services with       Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0025002004target population to affect knowledge, attitude and/or behavior)
H0026001003Alcohol and/or drug prevention process service, community-based (delivery of    Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0026002004services to develop skills of impactors)
H0027001003Alcohol and/or drug prevention environmental service (broad range of external   Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0027002004activities geared toward modifying systems in order to mainstream prevention
H0027003004through policy and law)
H0028001003Alcohol and/or drug prevention problem identification and referral service (e.  Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0028002004G. Student assistance and employee assistance programs), does not include
H0028003004assessment
H0029001003Alcohol and/or drug prevention alternatives service (services for populations   Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N
H0029002004that exclude alcohol and other drug use e. G. Alcohol free social events)
H0030001003Behavioral health hotline service                                               Alcohol and/or drug hotline 00      9                                                                                                     I                          Z2  9      02001010120030101        N
H0031001003Mental health assessment, by non-physician                                      MH health assess by non-md  00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0032001003Mental health service plan development by non-physician                         MH svc plan dev by non-md   00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0033001003Oral medication administration, direct observation                              Oral med adm direct observe 00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0034001003Medication training and support, per 15 minutes                                 Med trng & support per 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0035001003Mental health partial hospitalization, treatment, less than 24 hours            MH partial hosp tx under 24h00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0036001003Community psychiatric supportive treatment, face-to-face, per 15 minutes        Comm psy face-face per 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0037001003Community psychiatric supportive treatment program, per diem                    Comm psy sup tx pgm per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0038001003Self-help/peer services, per 15 minutes                                         Self-help/peer svc per 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0039001003Assertive community treatment, face-to-face, per 15 minutes                     Asser com tx face-face/15min00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0040001003Assertive community treatment program, per diem                                 Assert comm tx pgm per diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0041001003Foster care, child, non-therapeutic, per diem                                   Fos c chld non-ther per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0042001003Foster care, child, non-therapeutic, per month                                  Fos c chld non-ther per mon 00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0043001003Supported housing, per diem                                                     Supported housing, per diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0044001003Supported housing, per month                                                    Supported housing, per month00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0045001003Respite care services, not in the home, per diem                                Respite not-in-home per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0046001003Mental health services, not otherwise specified                                 Mental health service, nos  00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0047001003Alcohol and/or other drug abuse services, not otherwise specified               Alcohol/drug abuse svc nos  00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0048001003Alcohol and/or other drug testing: collection and handling only, specimens      Spec coll non-blood:a/d test00      9                                                                                                     I                          Z2  9      02003010120030101        N
H0048002004other than blood
H0049001003Alcohol and/or drug screening                                                   Alcohol/drug screening      00      9                                                                                                     I                          Z2  9      02007010120070101        N
H0050001003Alcohol and/or drug services, brief intervention, per 15 minutes                Alcohol/drug service 15 min 00      9                                                                                                     I                          Z2  9      02007010120070101        N
H1000001003Prenatal care, at-risk assessment                                               Prenatal care atrisk assessm00      9                                                                                                     I                          Z2  9      02002010120020101        N
H1001001003Prenatal care, at-risk enhanced service; antepartum management                  Antepartum management       00      9                                                                                                     I                          Z2  9      02002010120020101        N
H1002001003Prenatal care, at risk enhanced service; care coordination                      Carecoordination prenatal   00      9                                                                                                     I                          Z2  9      02002010120020101        N
H1003001003Prenatal care, at-risk enhanced service; education                              Prenatal at risk education  00      9                                                                                                     I                          Z2  9      02002010120020101        N
H1004001003Prenatal care, at-risk enhanced service; follow-up home visit                   Follow up home visit/prental00      9                                                                                                     I                          Z2  9      02002010120020101        N
H1005001003Prenatal care, at-risk enhanced service package (includes h1001-h1004)          Prenatalcare enhanced srv pk00      9                                                                                                     I                          Z2  9      02002010120020101        N
H1010001003Non-medical family planning education, per session                              Nonmed family planning ed   00      9                                                                                                     I                          Z2  9      02003010120030101        N
H1011001003Family assessment by licensed behavioral health professional for state defined  Family assessment           00      9                                                                                                     I                          Z2  9      02003010120030101        N
H1011002004purposes
H2000001003Comprehensive multidisciplinary evaluation                                      Comp multidisipln evaluation00      9                                                                                                     I                          Z2  9      02003010120030101        N
H2001001003Rehabilitation program, per 1/2 day                                             Rehabilitation program 1/2 d00      9                                                                                                     I                          Z2  9      02003010120030101        N
H2010001003Comprehensive medication services, per 15 minutes                               Comprehensive med svc 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2011001003Crisis intervention service, per 15 minutes                                     Crisis interven svc, 15 min 00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2012001003Behavioral health day treatment, per hour                                       Behav hlth day treat, per hr00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2013001003Psychiatric health facility service, per diem                                   Psych hlth fac svc, per diem00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2014001003Skills training and development, per 15 minutes                                 Skills train and dev, 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2015001003Comprehensive community support services, per 15 minutes                        Comp comm supp svc, 15 min  00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2016001003Comprehensive community support services, per diem                              Comp comm supp svc, per diem00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2017001003Psychosocial rehabilitation services, per 15 minutes                            Psysoc rehab svc, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2018001003Psychosocial rehabilitation services, per diem                                  Psysoc rehab svc, per diem  00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2019001003Therapeutic behavioral services, per 15 minutes                                 Ther behav svc, per 15 min  00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2020001003Therapeutic behavioral services, per diem                                       Ther behav svc, per diem    00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2021001003Community-based wrap-around services, per 15 minutes                            Com wrap-around sv, 15 min  00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2022001003Community-based wrap-around services, per diem                                  Com wrap-around sv, per diem00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2023001003Supported employment, per 15 minutes                                            Supported employ, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2024001003Supported employment, per diem                                                  Supported employ, per diem  00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2025001003Ongoing support to maintain employment, per 15 minutes                          Supp maint employ, 15 min   00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2026001003Ongoing support to maintain employment, per diem                                Supp maint employ, per diem 00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2027001003Psychoeducational service, per 15 minutes                                       Psychoed svc, per 15 min    00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2028001003Sexual offender treatment service, per 15 minutes                               Sex offend tx svc, 15 min   00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2029001003Sexual offender treatment service, per diem                                     Sex offend tx svc, per diem 00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2030001003Mental health clubhouse services, per 15 minutes                                MH clubhouse svc, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2031001003Mental health clubhouse services, per diem                                      MH clubhouse svc, per diem  00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2032001003Activity therapy, per 15 minutes                                                Activity therapy, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2033001003Multisystemic therapy for juveniles, per 15 minutes                             Multisys ther/juvenile 15min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2034001003Alcohol and/or drug abuse halfway house services, per diem                      A/D halfway house, per diem 00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2035001003Alcohol and/or other drug treatment program, per hour                           A/D tx program, per hour    00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2036001003Alcohol and/or other drug treatment program, per diem                           A/D tx program, per diem    00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2037001003Developmental delay prevention activities, dependent child of client, per 15    Dev delay prev dp ch, 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N
H2037002004minutes
J0120001003Injection, tetracycline, up to 250 mg                                           Tetracyclin injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0128001003Injection, abarelix, 10 mg                                                      Abarelix injection          51      A                                                                                                     C                          O1E 1P     0200501012011010120101231N
J0129001003Injection, abatacept, 10 mg (code may be used for medicare when drug            Abatacept injection         51      A                                                                                                     CYY20080101                O1E 1P     02007010120120101        N
J0129002004administered under the direct supervision of a physician, not for use when drug
J0129003004is self administered)
J0130001003Injection abciximab, 10 mg                                                      Abciximab injection         51      A                  2049                                                                               DYY20080101                O1E 1P     01999010119990101        N
J0131001003Injection, acetaminophen, 10 mg                                                 Acetaminophen injection     51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J0132001003Injection, acetylcysteine, 100 mg                                               Acetylcysteine injection    51      A                                                                                                     CYY20090101                O1E 1P     02006010120060101        N
J0133001003Injection, acyclovir, 5 mg                                                      Acyclovir injection         51      A                                                                                                     C                          O1E 1P     02006010120060101        N
J0135001003Injection, adalimumab, 20 mg                                                    Adalimumab injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J0150001003Injection, adenosine for therapeutic use,  6 mg (not to be used to report any   Injection adenosine 6 MG    51      A                  2049                                                                               D                          O1E 1P     01994010120050101        N
J0150002004adenosine phosphate compounds, instead use a9270)
J0152001003Injection, adenosine for diagnostic use, 30 mg (not to be used to report any    Adenosine injection         51      A                                                                                                     CYY20080101                O1E 1P     02004010120050101        N
J0152002004adenosine phosphate compounds; instead use a9270)
J0170001003Injection, adrenalin, epinephrine, up to 1 ml ampule                            Adrenalin epinephrin inject 51      A                  2049                                                                               D                          O1E 1P     0198601012011010120101231N
J0171001003Injection, adrenalin, epinephrine, 0. 1 mg                                      Adrenalin epinephrine inject51      A                  2049                                                                               D                          O1E 1P     02011010120110101        N
J0178001003Injection, aflibercept, 1 mg                                                    Aflibercept injection       51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        A
J0180001003Injection, agalsidase beta, 1 mg                                                Agalsidase beta injection   51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J0190001003Injection, biperiden lactate, per 5 mg                                          Inj biperiden lactate/5 mg  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0200001003Injection, alatrofloxacin mesylate, 100 mg                                      Alatrofloxacin mesylate     51      A                  2049.5                                                                             D                          O1E 1P     02000010120000101        N
J0205001003Injection, alglucerase, per 10 units                                            Alglucerase injection       51      A                  2049                                                                               DYY20080101                O1E 1P     01993010119970101        N
J0207001003Injection, amifostine, 500 mg                                                   Amifostine                  51      A                  2049                                                                               DYY20080101                O1D 1P     01998010119980101        N
J0210001003Injection, methyldopate  hcl, up to 250 mg                                      Methyldopate hcl injection  51      A                  2049                                                                               DYY20080101                O1E 1P     01984010119970101        N
J0215001003Injection, alefacept, 0. 5 mg                                                   Alefacept                   51      A                                                                                                     CYY20080101                O1E 1G     02004010120040101        N
J0220001003Injection, alglucosidase alfa, 10 mg, not otherwise specified                   Alglucosidase alfa injection51      A                                                                                                     CYY20080101                O1E 1P     02008010120120101        N
J0221001003Injection, alglucosidase alfa, (lumizyme), 10 mg                                Lumizyme injection          51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J0256001003Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg Alpha 1 proteinase inhibitor51      A                  2049                                                                               DYY20080101                O1E 1P     01989010120120101        N
J0257001003Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg               Glassia injection           51      A                  2049                                                                               DYY20120101                O1E 1P     02012010120120101        N
J0270001003Injection, alprostadil, 1. 25 mcg (code may be used for medicare when drug      Alprostadil for injection   51      A                  2049                                                                               D                          O1E 1      01997010120000101        N
J0270002004administered under the direct supervision of a physician, not for use when drug
J0270003004is self administered)
J0275001003Alprostadil urethral suppository (code may be used for medicare when drug       Alprostadil urethral suppos 51      A                  2049                                                                               D                          O1E 1      01999010120000101        N
J0275002004administered under the direct supervision of a physician, not for use when drug
J0275003004is self administered)
J0278001003Injection, amikacin sulfate, 100 mg                                             Amikacin sulfate injection  51      A                                                                                                     C                          O1E 1P     02006010120060101        N
J0280001003Injection, aminophyllin, up to 250 mg                                           Aminophyllin 250 MG inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N
J0282001003Injection, amiodarone hydrochloride, 30 mg                                      Amiodarone HCl              51      A                  2049                                                                               D                          O1E 1P     02001010120010101        N
J0285001003Injection, amphotericin b, 50 mg                                                Amphotericin B              51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N
J0287001003Injection, amphotericin b lipid complex, 10 mg                                  Amphotericin b lipid complex51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120030101        N
J0288001003Injection, amphotericin b cholesteryl sulfate complex, 10 mg                    Ampho b cholesteryl sulfate 51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120030101        N
J0289001003Injection, amphotericin b liposome, 10 mg                                       Amphotericin b liposome inj 51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120030101        N
J0290001003Injection, ampicillin sodium,  500 mg                                           Ampicillin 500 MG inj       51      A                  2049                                                                               D                          O1E 1P     01984010120000101        N
J0295001003Injection, ampicillin sodium/sulbactam sodium, per 1. 5 gm                      Ampicillin sodium per 1.5 gm51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N
J0300001003Injection, amobarbital, up to 125 mg                                            Amobarbital 125 MG inj      51      A                  2049                                                                               DYY20120101                O1E 1P     01982010119970101        N
J0330001003Injection, succinylcholine chloride, up to 20 mg                                Succinycholine chloride inj 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0348001003Injection, anidulafungin, 1 mg                                                  Anidulafungin injection     51      A                                                                                                     CYY20080101                O1E 1P     02007010120090101        N
J0350001003Injection, anistreplase, per 30 units                                           Injection anistreplase 30 u 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0360001003Injection, hydralazine hcl, up to 20 mg                                         Hydralazine hcl injection   51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0364001003Injection, apomorphine hydrochloride, 1 mg                                      Apomorphine hydrochloride   51      A                                                                                                     C                          O1E 1P     02007010120070101        N
J0365001003Injection, aprotonin, 10,000 kiu                                                Aprotonin, 10,000 kiu       51      A                  2049                                                                               DYY20130101            0095O1E 1P     02006010120060101        N
J0380001003Injection, metaraminol bitartrate, per 10 mg                                    Inj metaraminol bitartrate  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0390001003Injection, chloroquine hydrochloride, up to 250 mg                              Chloroquine injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0395001003Injection, arbutamine hcl, 1 mg                                                 Arbutamine hcl injection    51      A                  2049                                                                               DYY20130101                O1E 1P     01999010120090101        N
J0400001003Injection, aripiprazole, intramuscular, 0. 25 mg                                Aripiprazole injection      51      A                                                                                                     C                          O1E 1P     02008010120080101        N
J0456001003Injection, azithromycin, 500 mg                                                 Azithromycin                51      A                  2049.5                                                                             D                          O1E 1P     02000010120000101        N
J0460001003Injection, atropine sulfate, up to 0. 3 mg                                      Atropine sulfate injection  51      A                  2049                                                                               D                          O1E 1P     0198201012010010120091231N
J0461001003Injection, atropine sulfate, 0. 01 mg                                           Atropine sulfate injection  51      A                  2049                                                                               D                          O1E 1P     02010010120100101        N
J0470001003Injection, dimercaprol, per 100 mg                                              Dimecaprol injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0475001003Injection, baclofen, 10 mg                                                      Baclofen 10 MG injection    51      A                  2049                                                                               DYY20080101                O1E 1P     01994010119970101        N
J0476001003Injection, baclofen, 50 mcg for intrathecal trial                               Baclofen intrathecal trial  51      A                  2049                                                                               DYY20080101                O1E 1P     01999010119990101        N
J0480001003Injection, basiliximab, 20 mg                                                   Basiliximab                 51      A                  2049                                                                               DYY20080101            0095O1E 1G     02006010120060101        N
J0485001003Injection, belatacept, 1 mg                                                     Belatacept injection        51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        A
J0490001003Injection, belimumab, 10 mg                                                     Belimumab injection         51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J0500001003Injection, dicyclomine hcl, up to 20 mg                                         Dicyclomine injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0515001003Injection, benztropine mesylate, per 1 mg                                       Inj benztropine mesylate    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0520001003Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg          Bethanechol chloride inject 51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N
J0530001003Injection, penicillin g benzathine and penicillin g procaine, up to 600,000     Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     0198201012010010120091231N
J0530002004units
J0540001003Injection, penicillin g benzathine and penicillin g procaine, up to 1,200,000   Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     0198201012010010120091231N
J0540002004units
J0550001003Injection, penicillin g benzathine and penicillin g procaine, up to 2,400,000   Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     0198201012010010120091231N
J0550002004units
J0558001003Injection, penicillin g benzathine and penicillin g procaine, 100,000 units     PenG benzathine/procaine inj51      A                                                                                                     C                          O1E 1P     02011010120110101        N
J0559001003Injection, penicillin g benzathine and penicillin g procaine, 2500 units        PenG benzathine/procaine inj51      A                  2049                                                                               D                          O1E 1P     0201001012011010120101231N
J0560001003Injection, penicillin g benzathine, up to 600,000 units                         Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     0198201012011010120101231N
J0561001003Injection, penicillin g benzathine, 100,000 units                               Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     02011010120110101        N
J0570001003Injection, penicillin g benzathine, up to 1,200,000 units                       Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     0198201012011010120101231N
J0580001003Injection, penicillin g benzathine, up to 2,400,000 units                       Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     0198201012011010120101231N
J0583001003Injection, bivalirudin, 1 mg                                                    Bivalirudin                 51      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N
J0585001003Injection, onabotulinumtoxina, 1 unit                                           Injection,onabotulinumtoxinA51      A                  2049                                                                               DYY20080101                O1E 1P     01991010120100101        N
J0586001003Injection, abobotulinumtoxina, 5 units                                          AbobotulinumtoxinA          51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J0587001003Injection, rimabotulinumtoxinb, 100 units                                       Inj, rimabotulinumtoxinB    51      A                  2049                                                                               DYY20080101                O1E 1P     02002010120100101        N
J0588001003Injection, incobotulinumtoxin a, 1 unit                                         Incobotulinumtoxin a        51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J0592001003Injection, buprenorphine hydrochloride, 0. 1 mg                                 Buprenorphine hydrochloride 51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N
J0594001003Injection, busulfan, 1 mg                                                       Busulfan injection          51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J0595001003Injection, butorphanol tartrate, 1 mg                                           Butorphanol tartrate 1 mg   51      A                                                                                                     C                          O1E 1      02004010120040101        N
J0597001003Injection, c-1 esterase inhibitor (human), berinert, 10 units                   C-1 esterase, berinert      51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J0598001003Injection, c-1 esterase inhibitor (human), cinryze, 10 units                    C-1 esterase, cinryze       51      A                                                                                                     CYY20100101                O1E 1P     02010010120110101        N
J0600001003Injection, edetate calcium disodium, up to 1000 mg                              Edetate calcium disodium inj51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N
J0610001003Injection, calcium gluconate, per 10 ml                                         Calcium gluconate injection 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0620001003Injection, calcium glycerophosphate and calcium lactate, per 10 ml              Calcium glycer & lact/10 ML 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0630001003Injection, calcitonin salmon, up to 400 units                                   Calcitonin salmon injection 51      A                  2049                                                                               DYY20130101                O1E 1P     01982010119970101        N
J0636001003Injection, calcitriol, 0. 1 mcg                                                 Inj calcitriol per 0.1 mcg  51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N
J0637001003Injection, caspofungin acetate, 5 mg                                            Caspofungin acetate         51      A                                                                                                     CYY20080101                O1E 1P     02003010120030101        N
J0638001003Injection, canakinumab, 1 mg                                                    Canakinumab injection       51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J0640001003Injection, leucovorin calcium, per 50 mg                                        Leucovorin calcium injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0641001003Injection, levoleucovorin calcium, 0. 5 mg                                      Levoleucovorin injection    51      A                                                                                                     DYY20090101            0127O1E 1P     02009010120090101        N
J0670001003Injection, mepivacaine hydrochloride, per 10 ml                                 Inj mepivacaine HCL/10 ml   51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0690001003Injection, cefazolin sodium, 500 mg                                             Cefazolin sodium injection  51      A                  2049                                                                               D                          O1E 1P     01982010120000101        N
J0692001003Injection, cefepime hydrochloride, 500 mg                                       Cefepime HCl for injection  51      A                                                                                                     C                          O1E 1P     02002010120020101        N
J0694001003Injection, cefoxitin sodium, 1 gm                                               Cefoxitin sodium injection  51      A                  2049                                                      Q0090                    D                          O1E 1P     01992010119970101        N
J0696001003Injection, ceftriaxone sodium, per 250 mg                                       Ceftriaxone sodium injection51      A                  2049                                                                               D                          O1E 1P     01990010119970101        N
J0697001003Injection, sterile cefuroxime sodium, per 750 mg                                Sterile cefuroxime injection51      A                  2049                                                                               D                          O1E 1P     01990010119970101        N
J0698001003Injection, cefotaxime sodium, per gm                                            Cefotaxime sodium injection 51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N
J0702001003Injection, betamethasone acetate 3mg and betamethasone sodium phosphate 3mg     Betamethasone acet&sod phosp51      A                  2049                                                                               D                          O1E 1P     01995010120080101        N
J0704001003Injection, betamethasone sodium phosphate, per 4 mg                             Betamethasone sod phosp/4 MG51      A                  2049                                                                               D                          O1E 1P     0199501012011010120101231N
J0706001003Injection, caffeine citrate, 5mg                                                Caffeine citrate injection  51      A                                                                                                     C                          O1E 1P     02002010120020101        N
J0710001003Injection, cephapirin sodium, up to 1 gm                                        Cephapirin sodium injection 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0712001003Injection, ceftaroline fosamil, 10 mg                                           Ceftaroline fosamil inj     51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J0713001003Injection, ceftazidime, per 500 mg                                              Inj ceftazidime per 500 mg  51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J0715001003Injection, ceftizoxime sodium, per 500 mg                                       Ceftizoxime sodium / 500 MG 51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N
J0716001003Injection, centruroides immune f(ab)2, up to 120 milligrams                     Centruroides immune f(ab)   51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        A
J0718001003Injection, certolizumab pegol, 1 mg                                             Certolizumab pegol inj      51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J0720001003Injection, chloramphenicol sodium succinate, up to 1 gm                         Chloramphenicol sodium injec51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0725001003Injection, chorionic gonadotropin, per 1,000 usp units                          Chorionic gonadotropin/1000u51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0735001003Injection, clonidine hydrochloride, 1 mg                                        Clonidine hydrochloride     51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N
J0740001003Injection, cidofovir, 375 mg                                                    Cidofovir injection         51      A                  2049                                                                               DYY20080101                O1E 1P     01998010119980101        N
J0743001003Injection, cilastatin sodium; imipenem, per 250 mg                              Cilastatin sodium injection 51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N
J0744001003Injection, ciprofloxacin for intravenous infusion, 200 mg                       Ciprofloxacin iv            51      A                                                                                                     C                          O1E 1P     02002010120020101        N
J0745001003Injection, codeine phosphate, per 30 mg                                         Inj codeine phosphate /30 MG51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J0760001003Injection, colchicine, per 1mg                                                  Colchicine injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0770001003Injection, colistimethate sodium, up to 150 mg                                  Colistimethate sodium inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0775001003Injection, collagenase, clostridium histolyticum, 0. 01 mg                      Collagenase, clost hist inj 51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J0780001003Injection, prochlorperazine, up to 10 mg                                        Prochlorperazine injection  51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N
J0795001003Injection, corticorelin ovine triflutate, 1 microgram                           Corticorelin ovine triflutal51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J0800001003Injection, corticotropin, up to 40 units                                        Corticotropin injection     51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N
J0833001003Injection, cosyntropin, not otherwise specified, 0. 25 mg                       Cosyntropin injection NOS   51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J0834001003Injection, cosyntropin (cortrosyn), 0. 25 mg                                    Cosyntropin cortrosyn inj   51      A                                                                                                     C                          O1E 1P     02010010120100101        N
J0835001003Injection, cosyntropin, per 0. 25 mg                                            Inj cosyntropin per 0.25 MG 51      A                  2049                                                                               D                          O1E 1P     0199501012010010120091231N
J0840001003Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram               Crotalidae poly immune fab  51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J0850001003Injection, cytomegalovirus immune globulin intravenous (human), per vial        Cytomegalovirus imm IV /vial51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N
J0878001003Injection, daptomycin, 1 mg                                                     Daptomycin injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J0881001003Injection, darbepoetin alfa, 1 microgram (non-esrd use)                         Darbepoetin alfa, non-esrd  51      A                                                                                                     DYY20080101            0132O1E 1L     02006010120060101        N
J0882001003Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)                 Darbepoetin alfa, esrd use  57      A                  4273.1                                                                             D                          O1E 1L     02006010120060101        N
J0885001003Injection, epoetin alfa, (for non-esrd use), 1000 units                         Epoetin alfa, non-esrd      51      A                  2049                                                                               DYY20080101                O1E 9      02006010120060101        N
J0886001003Injection, epoetin alfa, 1000 units (for esrd on dialysis)                      Epoetin alfa 1000 units ESRD57      A                  4273.1                                                                             D                          O1E 1L     02006010120070101        N
J0890001003Injection, peginesatide, 0. 1 mg (for esrd on dialysis)                         Peginesatide injection      51      A                                                                                                     C                          O1E 1P     02013010120130101        A
J0894001003Injection, decitabine, 1 mg                                                     Decitabine injection        51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J0895001003Injection, deferoxamine mesylate, 500 mg                                        Deferoxamine mesylate inj   51      A                  2049                                                      Q0087                    D                          O1E 1P     01992010120010101        N
J0897001003Injection, denosumab, 1 mg                                                      Denosumab injection         51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J0900001003Injection, testosterone enanthate and estradiol valerate, up to 1 cc            Testosterone enanthate inj  51      A                  2049                                                                               DYY20130101                O1E 1P     01982010119970101        N
J0945001003Injection, brompheniramine maleate, per 10 mg                                   Brompheniramine maleate inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J0970001003Injection, estradiol valerate, up to 40 mg                                      Estradiol valerate injection51      A                  2049                                                                               D                          O1E 1P     0198201012011010120101231N
J1000001003Injection, depo-estradiol cypionate, up to 5 mg                                 Depo-estradiol cypionate inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1020001003Injection, methylprednisolone acetate, 20 mg                                    Methylprednisolone 20 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1030001003Injection, methylprednisolone acetate, 40 mg                                    Methylprednisolone 40 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1040001003Injection, methylprednisolone acetate, 80 mg                                    Methylprednisolone 80 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1050001003Injection, medroxyprogesterone acetate, 1 mg                                    Medroxyprogesterone acetate 51      A                                                                                                     C                          O1E 1P     02013010120130101        A
J1051001003Injection, medroxyprogesterone acetate, 50 mg                                   Medroxyprogesterone inj     51      A                  2049                                                                               D                          O1E 1P     0200301012013010120121231D
J1055001003Injection, medroxyprogesterone acetate for contraceptive use, 150 mg            Medrxyprogester acetate inj 00      9                                          1862A1                                                     S                          O1E 1P     0199401012013010120121231D
J1056001003Injection, medroxyprogesterone acetate / estradiol cypionate, 5mg / 25mg        MA/EC contraceptiveinjection51      A                                                                                                     C                          O1E 1P     0200201012013010120121231D
J1060001003Injection, testosterone cypionate and estradiol cypionate, up to 1 ml           Testosterone cypionate 1 ML 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1070001003Injection, testosterone cypionate, up to 100 mg                                 Testosterone cypionat 100 MG51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1080001003Injection, testosterone cypionate, 1 cc, 200 mg                                 Testosterone cypionat 200 MG51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1094001003Injection, dexamethasone acetate, 1 mg                                          Inj dexamethasone acetate   51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N
J1100001003Injection, dexamethasone sodium phosphate, 1mg                                  Dexamethasone sodium phos   51      A                  2049                                                                               D                          O1E 1P     01982010120010101        N
J1110001003Injection, dihydroergotamine mesylate, per 1 mg                                 Inj dihydroergotamine mesylt51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1120001003Injection, acetazolamide sodium, up to 500 mg                                   Acetazolamid sodium injectio51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1160001003Injection, digoxin, up to 0. 5 mg                                               Digoxin injection           51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1162001003Injection, digoxin immune fab (ovine), per vial                                 Digoxin immune fab (ovine)  51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J1165001003Injection, phenytoin sodium, per 50 mg                                          Phenytoin sodium injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1170001003Injection, hydromorphone, up to 4 mg                                            Hydromorphone injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1180001003Injection, dyphylline, up to 500 mg                                             Dyphylline injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1190001003Injection, dexrazoxane hydrochloride, per 250 mg                                Dexrazoxane HCl injection   51      A                  2049                                                                               DYY20080101                O1E 1P     01997010119970101        N
J1200001003Injection, diphenhydramine hcl, up to 50 mg                                     Diphenhydramine hcl injectio51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1205001003Injection, chlorothiazide sodium, per 500 mg                                    Chlorothiazide sodium inj   51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N
J1212001003Injection, dmso, dimethyl sulfoxide, 50%, 50 ml                                 Dimethyl sulfoxide 50% 50 ML51      A45-23             2049                                                                               DYY20090101                O1E 1P     01986010119970101        N
J1230001003Injection, methadone hcl, up to 10 mg                                           Methadone injection         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1240001003Injection, dimenhydrinate, up to 50 mg                                          Dimenhydrinate injection    51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N
J1245001003Injection, dipyridamole, per 10 mg                                              Dipyridamole injection      51      A                  15030   2049                                                                       D                          O1E 1P     01993010119980101        N
J1250001003Injection, dobutamine hydrochloride, per 250 mg                                 Inj dobutamine HCL/250 mg   51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J1260001003Injection, dolasetron mesylate, 10 mg                                           Dolasetron mesylate         51      A                  2049                                                                               D                          O1D 1P     01999010120000101        N
J1265001003Injection, dopamine hcl, 40 mg                                                  Dopamine injection          51      A                                                                                                     C                          O1E 1P     02006010120060101        N
J1267001003Injection, doripenem, 10 mg                                                     Doripenem injection         51      A                                                                                                     C                          O1E 1P     02009010120090101        N
J1270001003Injection, doxercalciferol, 1 mcg                                               Injection, doxercalciferol  51      A                                                                                                     C                          O1E 1P     02002010120020101        N
J1290001003Injection, ecallantide, 1 mg                                                    Ecallantide injection       51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J1300001003Injection, eculizumab, 10 mg                                                    Eculizumab injection        51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N
J1320001003Injection, amitriptyline hcl, up to 20 mg                                       Amitriptyline injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1324001003Injection, enfuvirtide, 1 mg                                                    Enfuvirtide injection       51      A                                                                                                     CYY20100101                O1E 1P     02007010120070101        N
J1325001003Injection, epoprostenol, 0. 5 mg                                                Epoprostenol injection      51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N
J1327001003Injection, eptifibatide, 5 mg                                                   Eptifibatide injection      51      A                  2049                                                                               DYY20080101                O1E 1P     02000010120000101        N
J1330001003Injection, ergonovine maleate, up to 0. 2 mg                                    Ergonovine maleate injection51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J1335001003Injection, ertapenem sodium, 500 mg                                             Ertapenem injection         51      A                                                                                                     C                          O1E 1P     02004010120040101        N
J1364001003Injection, erythromycin lactobionate, per 500 mg                                Erythro lactobionate /500 MG51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N
J1380001003Injection, estradiol valerate, up to 10 mg                                      Estradiol valerate 10 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1390001003Injection, estradiol valerate, up to 20 mg                                      Estradiol valerate 20 MG inj51      A                  2049                                                                               D                          O1E 1P     0198201012011010120101231N
J1410001003Injection, estrogen  conjugated, per 25 mg                                      Inj estrogen conjugate 25 MG51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N
J1430001003Injection, ethanolamine oleate, 100 mg                                          Ethanolamine oleate 100 mg  51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J1435001003Injection, estrone, per 1 mg                                                    Injection estrone per 1 MG  51      A                  2049                                                                               DYY20130101                O1E 1P     01982010119970101        N
J1436001003Injection, etidronate disodium, per 300 mg                                      Etidronate disodium inj     51      A                  2049                                                                               D                          O1E 1P     01990010119970101        N
J1438001003Injection, etanercept, 25 mg (code may be used for medicare when drug           Etanercept injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02000010120000101        N
J1438002004administered under the direct supervision of a physician, not for use when drug
J1438003004is self administered)
J1440001003Injection, filgrastim (g-csf), 300 mcg                                          Filgrastim 300 mcg injection51      A                  2049                                                                               DYY20080101                O1E 1P     01994010119970101        N
J1441001003Injection, filgrastim (g-csf), 480 mcg                                          Filgrastim 480 mcg injection51      A                  2049                                                                               DYY20080101                O1E 1P     01994010119970101        N
J1450001003Injection fluconazole, 200 mg                                                   Fluconazole                 51      A                  2049.5                                                                             D                          O1E 1P     02000010120000101        N
J1451001003Injection, fomepizole, 15 mg                                                    Fomepizole, 15 mg           51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J1452001003Injection, fomivirsen sodium, intraocular, 1. 65 mg                             Intraocular Fomivirsen na   51      A                  2049.3                                                                             DYY20130101                O1E 1P     02001010120010101        N
J1453001003Injection, fosaprepitant, 1 mg                                                  Fosaprepitant injection     51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        N
J1455001003Injection, foscarnet sodium, per 1000 mg                                        Foscarnet sodium injection  51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N
J1457001003Injection, gallium nitrate, 1 mg                                                Gallium nitrate injection   51      A                                                                                                     C                          O1E 1P     02005010120050101        N
J1458001003Injection, galsulfase, 1 mg                                                     Galsulfase injection        51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J1459001003Injection, immune globulin (privigen), intravenous, non-lyophilized (e. G.      Inj IVIG privigen 500 mg    51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        N
J1459002004Liquid), 500 mg
J1460001003Injection, gamma globulin, intramuscular, 1 cc                                  Gamma globulin 1 CC inj     51      A                  2049                                                                               DYY20080101                O1E 1P     01984010119970101        N
J1470001003Injection, gamma globulin, intramuscular, 2 cc                                  Gamma globulin 2 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1480001003Injection, gamma globulin, intramuscular, 3 cc                                  Gamma globulin 3 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198501012011010120101231N
J1490001003Injection, gamma globulin, intramuscular, 4 cc                                  Gamma globulin 4 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1500001003Injection, gamma globulin, intramuscular, 5 cc                                  Gamma globulin 5 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1510001003Injection, gamma globulin, intramuscular, 6 cc                                  Gamma globulin 6 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1520001003Injection, gamma globulin, intramuscular, 7 cc                                  Gamma globulin 7 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1530001003Injection, gamma globulin, intramuscular, 8 cc                                  Gamma globulin 8 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1540001003Injection, gamma globulin, intramuscular, 9 cc                                  Gamma globulin 9 CC inj     51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1550001003Injection, gamma globulin, intramuscular, 10 cc                                 Gamma globulin 10 CC inj    51      A                  2049                                                                               D                          O1E 1P     0198401012011010120101231N
J1557001003Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e. G.    Gammaplex injection         51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J1557002004Liquid), 500 mg
J1559001003Injection, immune globulin (hizentra), 100 mg                                   Hizentra injection          51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J1560001003Injection, gamma globulin, intramuscular, over 10 cc                            Gamma globulin > 10 CC inj  51      A                  2049                                                                               DYY20080101                O1E 1P     01984010119970101        N
J1561001003Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e. G.        Gamunex-C/Gammaked          51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120130101        C
J1561002004Liquid), 500 mg
J1562001003Injection, immune globulin (vivaglobin), 100 mg                                 Vivaglobin, inj             51      A                                                                                                     CYY20080101                O1E 1P     02007010120080101        N
J1565001003Injection, respiratory syncytial virus immune globulin, intravenous, 50 mg      RSV-ivig                    51      A                  2049                                                                               D                          O1E 1P     0199801012010010120091231N
J1566001003Injection, immune globulin, intravenous, lyophilized (e. G. Powder), not        Immune globulin, powder     51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120080101        N
J1566002004otherwise specified, 500 mg
J1568001003Injection, immune globulin, (octagam), intravenous, non-lyophilized (e. G.      Octagam injection           51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N
J1568002004Liquid), 500 mg
J1569001003Injection, immune globulin, (gammagard liquid), non-lyophilized, (e. G.         Gammagard liquid injection  51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120130101        C
J1569002004Liquid), 500 mg
J1570001003Injection, ganciclovir sodium, 500 mg                                           Ganciclovir sodium injection51      A                  2049                                                                               DYY20120101                O1E 1P     01994010119970101        N
J1571001003Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0. 5 ml      Hepagam b im injection      51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120090101        N
J1572001003Injection, immune globulin, (flebogamma/flebogamma dif), intravenous,           Flebogamma injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120090101        N
J1572002004non-lyophilized (e. G. Liquid), 500 mg
J1573001003Injection, hepatitis b immune globulin (hepagam b), intravenous, 0. 5 ml        Hepagam b intravenous, inj  51      A                                                                                                     CYY20080101                O1E 1P     02008010120090101        N
J1580001003Injection, garamycin, gentamicin, up to 80 mg                                   Garamycin gentamicin inj    51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N
J1590001003Injection, gatifloxacin, 10mg                                                   Gatifloxacin injection      51      A                                                                                                     CYY20130101                O1E 1P     02002010120020101        N
J1595001003Injection, glatiramer acetate, 20 mg                                            Injection glatiramer acetate51      A                  2049                                                                               DYY20080101                O1E 1P     02004010120040101        N
J1599001003Injection, immune globulin, intravenous, non-lyophilized (e. G. Liquid), not    Ivig non-lyophilized, NOS   51      A                                                                                                     C                          O1E 1P     02011010120110101        N
J1599002004otherwise specified, 500 mg
J1600001003Injection, gold sodium thiomalate, up to 50 mg                                  Gold sodium thiomaleate inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1610001003Injection, glucagon hydrochloride, per 1 mg                                     Glucagon hydrochloride/1 MG 51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119970101        N
J1620001003Injection, gonadorelin hydrochloride, per 100 mcg                               Gonadorelin hydroch/ 100 mcg51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N
J1626001003Injection, granisetron hydrochloride, 100 mcg                                   Granisetron hcl injection   51      A                  2049                                                                               D                          O1E 1P     01998010120090101        N
J1630001003Injection, haloperidol, up to 5 mg                                              Haloperidol injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J1631001003Injection, haloperidol decanoate, per 50 mg                                     Haloperidol decanoate inj   51      A                  2049                                                                               D                          O1E 1P     01989010119970101        N
J1640001003Injection, hemin, 1 mg                                                          Hemin, 1 mg                 51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J1642001003Injection, heparin sodium, (heparin lock flush), per 10 units                   Inj heparin sodium per 10 u 51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N
J1644001003Injection, heparin sodium, per 1000 units                                       Inj heparin sodium per 1000u51      A                  2049                                                                               D                          O1E 1LP    01995010120030101        N
J1645001003Injection, dalteparin sodium, per 2500 iu                                       Dalteparin sodium           51      A                  2049                                                                               D                          O1E 1P     01997010120020701        N
J1650001003Injection, enoxaparin sodium, 10 mg                                             Inj enoxaparin sodium       51      A                                                                                                     C                          O1E 1P     01996010120040101        N
J1652001003Injection, fondaparinux sodium, 0. 5 mg                                         Fondaparinux sodium         51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N
J1655001003Injection, tinzaparin sodium, 1000 iu                                           Tinzaparin sodium injection 51      A                                                                                                     C                          O1E 1P     02002010120020701        N
J1670001003Injection, tetanus immune globulin, human, up to 250 units                      Tetanus immune globulin inj 51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119970101        N
J1675001003Injection, histrelin acetate, 10 micrograms                                     Histrelin acetate           51      A                  2049                                                                               D                      0095O1E 1G     02006010120060101        N
J1680001003Injection, human fibrinogen concentrate, 100 mg                                 Human fibrinogen conc inj   00      9                                                                                                     I                          O1E 1P     0201001012013010120121231D
J1700001003Injection, hydrocortisone acetate, up to 25 mg                                  Hydrocortisone acetate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1710001003Injection, hydrocortisone sodium  phosphate, up to 50 mg                        Hydrocortisone sodium ph inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1720001003Injection, hydrocortisone sodium succinate, up to 100 mg                        Hydrocortisone sodium succ i51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1725001003Injection, hydroxyprogesterone caproate, 1 mg                                   Hydroxyprogesterone caproate51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J1730001003Injection, diazoxide, up to 300 mg                                              Diazoxide injection         51      A                  2049                                                                               DYY20130101                O1E 1P     01982010119970101        N
J1740001003Injection, ibandronate sodium, 1 mg                                             Ibandronate sodium injection51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J1741001003Injection, ibuprofen, 100 mg                                                    Ibuprofen injection         51      A                                                                                                     C                          O1E 1P     02013010120130101        A
J1742001003Injection, ibutilide fumarate, 1 mg                                             Ibutilide fumarate injection51      A                  2049                                                                               DYY20080101                O1E 1P     01998010119980101        N
J1743001003Injection, idursulfase, 1 mg                                                    Idursulfase injection       51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N
J1744001003Injection, icatibant, 1 mg                                                      Icatibant injection         51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        A
J1745001003Injection infliximab, 10 mg                                                     Infliximab injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02000010120000101        N
J1750001003Injection, iron dextran, 50 mg                                                  Inj iron dextran            51      A                  2049.5                                                                             DYY20090101                O1E 1P     02005123120090101        N
J1756001003Injection, iron sucrose, 1 mg                                                   Iron sucrose injection      51      A                                                                                                     C                          O1E 1P     02003010120030101        N
J1785001003Injection, imiglucerase, per unit                                               Injection imiglucerase /unit51      A                  2049                                                                               D                          O1E 1P     0199501012011010120101231N
J1786001003Injection, imiglucerase, 10 units                                               Imuglucerase injection      51      A                  2049                                                                               DYY20110101                O1E 1P     02011010120110101        N
J1790001003Injection, droperidol, up to 5 mg                                               Droperidol injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1800001003Injection, propranolol hcl, up to 1 mg                                          Propranolol injection       51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1810001003Injection, droperidol and fentanyl citrate, up to 2 ml ampule                   Droperidol/fentanyl inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1815001003Injection, insulin, per 5 units                                                 Insulin injection           51      A60-14             2049                                                                               D                          O1E 1P     02003010120030101        N
J1817001003Insulin for administration through dme (i. E. , insulin pump) per 50 units      Insulin for insulin pump use51      A                                                                                                     C                          D1G 1P     02003010120030101        N
J1825001003Injection, interferon beta-1a, 33 mcg                                           Interferon beta-1a          00      9                                                                                                     I                          O1E 1      0199801012011010120101231N
J1826001003Injection, interferon beta-1a, 30 mcg                                           Interferon Beta-1A inj      00      9                                                                                                     I                          O1E 1      02011010120110101        N
J1830001003Injection interferon beta-1b, 0. 25 mg (code may be used for medicare when drug Interferon beta-1b / .25 MG 51      A                  2049                                                                               DYY20080101                O1E 1      01982010120000101        N
J1830002004administered under the direct supervision of a physician, not for  use when
J1830003004drug is self administered)
J1835001003Injection, itraconazole, 50 mg                                                  Itraconazole injection      51      A                                                                                                     CYY20120101                O1E 1P     02002010120020101        N
J1840001003Injection, kanamycin sulfate, up to 500 mg                                      Kanamycin sulfate 500 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1850001003Injection, kanamycin sulfate, up to 75 mg                                       Kanamycin sulfate 75 MG inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1885001003Injection, ketorolac tromethamine, per 15 mg                                    Ketorolac tromethamine inj  51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N
J1890001003Injection, cephalothin sodium, up to 1 gram                                     Cephalothin sodium injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1930001003Injection, lanreotide, 1 mg                                                     Lanreotide injection        51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        N
J1931001003Injection, laronidase, 0. 1 mg                                                  Laronidase injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J1940001003Injection, furosemide, up to 20 mg                                              Furosemide injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1945001003Injection, lepirudin, 50 mg                                                     Lepirudin                   51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J1950001003Injection, leuprolide acetate (for depot suspension), per 3. 75 mg              Leuprolide acetate /3.75 MG 51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119970101        N
J1953001003Injection, levetiracetam, 10 mg                                                 Levetiracetam injection     51      A                                                                                                     C                          O1E 1P     02009010120090101        N
J1955001003Injection, levocarnitine, per 1 gm                                              Inj levocarnitine per 1 gm  51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J1956001003Injection, levofloxacin, 250 mg                                                 Levofloxacin injection      51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N
J1960001003Injection, levorphanol tartrate, up to 2 mg                                     Levorphanol tartrate inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1980001003Injection, hyoscyamine sulfate, up to 0. 25 mg                                  Hyoscyamine sulfate inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J1990001003Injection, chlordiazepoxide hcl, up to 100 mg                                   Chlordiazepoxide injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2001001003Injection, lidocaine hcl for intravenous infusion, 10 mg                        Lidocaine injection         51      A                  2049                                                                               D                          O1E 1P     02004010120040101        N
J2010001003Injection, lincomycin hcl, up to 300 mg                                         Lincomycin injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2020001003Injection, linezolid, 200mg                                                     Linezolid injection         51      A                                                                                                     CYY20080101                O1E 1P     02002010120020101        N
J2060001003Injection, lorazepam, 2 mg                                                      Lorazepam injection         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2150001003Injection, mannitol, 25% in 50 ml                                               Mannitol injection          51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2170001003Injection, mecasermin, 1 mg                                                     Mecasermin injection        51      A                                                                                                     C                          O1E 1P     02007010120070101        N
J2175001003Injection, meperidine hydrochloride, per 100 mg                                 Meperidine hydrochl /100 MG 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2180001003Injection, meperidine and promethazine hcl, up to 50 mg                         Meperidine/promethazine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2185001003Injection, meropenem, 100 mg                                                    Meropenem                   51      A                                                                                                     C                          O1E 1P     02004010120040101        N
J2210001003Injection, methylergonovine maleate, up to 0. 2 mg                              Methylergonovin maleate inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2212001003Injection, methylnaltrexone, 0. 1 mg                                            Methylnaltrexone injection  51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        A
J2248001003Injection, micafungin sodium, 1 mg                                              Micafungin sodium injection 51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J2250001003Injection, midazolam hydrochloride, per 1 mg                                    Inj midazolam hydrochloride 51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J2260001003Injection, milrinone lactate, 5 mg                                              Inj milrinone lactate / 5 MG51      A                  2049                                                                               D                          O1E 1P     01986010120010101        N
J2265001003Injection, minocycline hydrochloride, 1 mg                                      Minocycline hydrochloride   51      A                                                                                                     C                          O1E 1P     02012010120120101        N
J2270001003Injection, morphine sulfate, up to 10 mg                                        Morphine sulfate injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2271001003Injection, morphine sulfate, 100mg                                              Morphine so4 injection 100mg51      A60-14a            2049                                                                               D                          O1E 1P     01999010120010101        N
J2275001003Injection, morphine sulfate (preservative-free sterile solution), per 10 mg     Morphine sulfate injection  51      A60-14b            2049                                                                               D                          O1E 1P     01993010120010101        N
J2278001003Injection, ziconotide, 1 microgram                                              Ziconotide injection        51      A                                                                                                     DYY20080101            0123O1E 1P     02006010120060101        N
J2280001003Injection, moxifloxacin, 100 mg                                                 Inj, moxifloxacin 100 mg    51      A                                                                                                     C                          O1E 1P     02004010120040101        N
J2300001003Injection, nalbuphine hydrochloride, per 10 mg                                  Inj nalbuphine hydrochloride51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J2310001003Injection, naloxone hydrochloride, per 1 mg                                     Inj naloxone hydrochloride  51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J2315001003Injection, naltrexone, depot form, 1 mg                                         Naltrexone, depot form      51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J2320001003Injection, nandrolone decanoate, up to 50 mg                                    Nandrolone decanoate 50 MG  51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2321001003Injection, nandrolone decanoate, up to 100 mg                                   Nandrolone decanoate 100 MG 51      A                  2049                                                                               D                          O1E 1P     0198701012011010120101231N
J2322001003Injection, nandrolone decanoate, up to 200 mg                                   Nandrolone decanoate 200 MG 51      A                  2049                                                                               D                          O1E 1P     0198701012011010120101231N
J2323001003Injection, natalizumab, 1 mg                                                    Natalizumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N
J2325001003Injection, nesiritide, 0. 1 mg                                                  Nesiritide injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120060101        N
J2353001003Injection, octreotide, depot form for intramuscular injection, 1 mg             Octreotide injection, depot 51      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N
J2354001003Injection, octreotide, non-depot form for subcutaneous or intravenous           Octreotide inj, non-depot   51      A                                                                                                     C                          O1E 1P     02004010120040101        N
J2354002004injection, 25 mcg
J2355001003Injection, oprelvekin, 5 mg                                                     Oprelvekin injection        51      A                  2049                                                                               DYY20080101                O1E 1P     01999010119990101        N
J2357001003Injection, omalizumab, 5 mg                                                     Omalizumab injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J2358001003Injection, olanzapine, long-acting, 1 mg                                        Olanzapine long-acting inj  51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J2360001003Injection, orphenadrine citrate, up to 60 mg                                    Orphenadrine injection      51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2370001003Injection, phenylephrine hcl, up to 1 ml                                        Phenylephrine hcl injection 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2400001003Injection, chloroprocaine hydrochloride, per 30 ml                              Chloroprocaine hcl injection51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2405001003Injection, ondansetron hydrochloride, per 1 mg                                  Ondansetron hcl injection   51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N
J2410001003Injection, oxymorphone hcl, up to 1 mg                                          Oxymorphone hcl injection   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2425001003Injection, palifermin, 50 micrograms                                            Palifermin injection        51      A                                                                                                     CYY20080101                O1E 1P     02006010120060101        N
J2426001003Injection, paliperidone palmitate extended release, 1 mg                        Paliperidone palmitate inj  51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J2430001003Injection, pamidronate disodium, per 30 mg                                      Pamidronate disodium /30 MG 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2440001003Injection, papaverine hcl, up to 60 mg                                          Papaverin hcl injection     51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2460001003Injection, oxytetracycline hcl, up to 50 mg                                     Oxytetracycline injection   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2469001003Injection, palonosetron hcl, 25 mcg                                             Palonosetron hcl            51      A                                                                                                     CYY20080101                O1E 1P     02005010120090101        N
J2501001003Injection, paricalcitol, 1 mcg                                                  Paricalcitol                51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N
J2503001003Injection, pegaptanib sodium, 0. 3 mg                                           Pegaptanib sodium injection 51      A                                                                                                     CYY20080101            0095O1E 1P     02006010120060101        N
J2504001003Injection, pegademase bovine, 25 iu                                             Pegademase bovine, 25 iu    51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J2505001003Injection, pegfilgrastim, 6 mg                                                  Injection, pegfilgrastim 6mg53      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N
J2507001003Injection, pegloticase, 1 mg                                                    Pegloticase injection       51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J2510001003Injection, penicillin g procaine, aqueous, up to 600,000 units                  Penicillin g procaine inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2513001003Injection, pentastarch, 10% solution, 100 ml                                    Pentastarch 10% solution    51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        N
J2515001003Injection, pentobarbital sodium, per 50 mg                                      Pentobarbital sodium inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2540001003Injection, penicillin g potassium, up to 600,000 units                          Penicillin g potassium inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2543001003Injection, piperacillin sodium/tazobactam sodium, 1 gram/0. 125 grams (1. 125   Piperacillin/tazobactam     51      A                  2049                                                                               D                          O1E 1P     02000010120010101        N
J2543002004grams)
J2545001003Pentamidine isethionate, inhalation solution, fda-approved final product,       Pentamidine non-comp unit   51      A                                                                                                     D                      0127D1G 1P     01992010120080101        N
J2545002004non-compounded, administered through dme, unit dose form, per 300 mg
J2550001003Injection, promethazine hcl, up to 50 mg                                        Promethazine hcl injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2560001003Injection, phenobarbital sodium, up to 120 mg                                   Phenobarbital sodium inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2562001003Injection, plerixafor, 1 mg                                                     Plerixafor injection        51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J2590001003Injection, oxytocin, up to 10 units                                             Oxytocin injection          51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2597001003Injection, desmopressin acetate, per 1 mcg                                      Inj desmopressin acetate    51      A                  2049                                                                               DYY20130101                O1E 1P     01996010119970101        N
J2650001003Injection, prednisolone acetate, up to 1 ml                                     Prednisolone acetate inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2670001003Injection, tolazoline hcl, up to 25 mg                                          Totazoline hcl injection    51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2675001003Injection, progesterone, per 50 mg                                              Inj progesterone per 50 MG  51      A                  2049                                                                               D                          O1E 1P     01986010120020701        N
J2680001003Injection, fluphenazine decanoate, up to 25 mg                                  Fluphenazine decanoate 25 MG51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2690001003Injection, procainamide hcl, up to 1 gm                                         Procainamide hcl injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2700001003Injection, oxacillin sodium, up to 250 mg                                       Oxacillin sodium injeciton  51      A                  2049                                                                               DYY20120101                O1E 1P     01982010119970101        N
J2710001003Injection, neostigmine methylsulfate, up to 0. 5 mg                             Neostigmine methylslfte inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2720001003Injection, protamine sulfate, per 10 mg                                         Inj protamine sulfate/10 MG 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2724001003Injection, protein c concentrate, intravenous, human, 10 iu                     Protein c concentrate       51      A                                                                                                     CYY20080101                O1E 1P     02008010120090101        N
J2725001003Injection, protirelin, per 250 mcg                                              Inj protirelin per 250 mcg  51      A                  2049                                                                               DYY20120101                O1E 1P     01995010119970101        N
J2730001003Injection, pralidoxime chloride, up to 1 gm                                     Pralidoxime chloride inj    51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119970101        N
J2760001003Injection, phentolamine mesylate, up to 5 mg                                    Phentolaine mesylate inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2765001003Injection, metoclopramide hcl, up to 10 mg                                      Metoclopramide hcl injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2770001003Injection, quinupristin/dalfopristin, 500 mg (150/350)                          Quinupristin/dalfopristin   51      A                  2049                                                                               DYY20080101                O1E 1P     02001010120010101        N
J2778001003Injection, ranibizumab, 0. 1 mg                                                 Ranibizumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N
J2780001003Injection, ranitidine hydrochloride, 25 mg                                      Ranitidine hydrochloride inj51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N
J2783001003Injection, rasburicase, 0. 5 mg                                                 Rasburicase                 51      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N
J2785001003Injection, regadenoson, 0. 1 mg                                                 Regadenoson injection       51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        N
J2788001003Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i. U. )   Rho d immune globulin 50 mcg51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120090101        N
J2790001003Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i. U. )Rho d immune globulin inj   51      A                  2049                                                                               DYY20080101                O1E 1P     01986010120090101        N
J2791001003Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or        Rhophylac injection         51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120080101        N
J2791002004intravenous, 100 iu
J2792001003Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu Rho(D) immune globulin h, sd51      A                  2049                                                                               DYY20080101                O1E 1P     01999010119990101        N
J2793001003Injection, rilonacept, 1 mg                                                     Rilonacept injection        51      A                  2049                                                                               DYY20100101                O1E 1P     02010010120100101        N
J2794001003Injection, risperidone, long acting, 0. 5 mg                                    Risperidone, long acting    51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J2795001003Injection, ropivacaine hydrochloride, 1 mg                                      Ropivacaine HCl injection   51      A                                                                                                     C                          O1E 1P     02001010120010101        N
J2796001003Injection, romiplostim, 10 micrograms                                           Romiplostim injection       51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J2800001003Injection, methocarbamol, up to 10 ml                                           Methocarbamol injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2805001003Injection, sincalide, 5 micrograms                                              Sincalide injection         51      A                                                                                                     C                          O1E 1P     02006010120060101        N
J2810001003Injection, theophylline, per 40 mg                                              Inj theophylline per 40 MG  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2820001003Injection, sargramostim (gm-csf), 50 mcg                                        Sargramostim injection      51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119980101        N
J2850001003Injection, secretin, synthetic, human, 1 microgram                              Inj secretin synthetic human51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120060101        N
J2910001003Injection, aurothioglucose, up to 50 mg                                         Aurothioglucose injeciton   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2916001003Injection, sodium ferric gluconate complex in sucrose injection, 12. 5 mg       Na ferric gluconate complex 51      A                  2049.2  2049.4                                                                     D                          O1E 1P     02003010120030101        N
J2920001003Injection, methylprednisolone sodium succinate, up to 40 mg                     Methylprednisolone injection51      A                  2049                                                                               D                          O1E 1G     01982010119970101        N
J2930001003Injection, methylprednisolone sodium succinate, up to 125 mg                    Methylprednisolone injection51      A                  2049                                                                               D                          O1E 1G     01984010119970101        N
J2940001003Injection, somatrem, 1 mg                                                       Somatrem injection          51      A                  2049                    1861s2b                                                    D                          O1E 1P     02002010120020101        N
J2941001003Injection, somatropin, 1 mg                                                     Somatropin injection        51      A                  2049                    1861s2b                                                    DYY20080101                O1E 1P     02002010120020101        N
J2950001003Injection, promazine hcl, up to 25 mg                                           Promazine hcl injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J2993001003Injection, reteplase, 18. 1 mg                                                  Reteplase injection         51      A                  2049                                                                               DYY20080101                O1E 1P     02001010120010101        N
J2995001003Injection, streptokinase, per 250,000 iu                                        Inj streptokinase /250000 IU51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J2997001003Injection, alteplase recombinant, 1 mg                                          Alteplase recombinant       51      A                  2049                                                                               DYY20080101                O1E 1P     02001010120010101        N
J3000001003Injection, streptomycin, up to 1 gm                                             Streptomycin injection      51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3010001003Injection, fentanyl citrate, 0. 1 mg                                            Fentanyl citrate injeciton  51      A                  2049                                                                               D                          O1E 1P     01982010120010101        N
J3030001003Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug Sumatriptan succinate / 6 MG51      A                  2049                                                                               D                          O1E 1P     01986010120000101        N
J3030002004administered under the direct supervision of a physician, not for use when drug
J3030003004is self administered)
J3070001003Injection, pentazocine, 30 mg                                                   Pentazocine injection       51      A                  2049                                                                               D                          O1E 1P     01982010120030101        N
J3095001003Injection, telavancin, 10 mg                                                    Telavancin injection        51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J3101001003Injection, tenecteplase, 1 mg                                                   Tenecteplase injection      51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        N
J3105001003Injection, terbutaline sulfate, up to 1 mg                                      Terbutaline sulfate inj     51      A                  2049                                                                               D                          O1E 1P     01987010119970101        N
J3110001003Injection, teriparatide, 10 mcg                                                 Teriparatide injection      51      A                                                                                                     D                      0120O1E 1P     02005010120050101        N
J3120001003Injection, testosterone enanthate, up to 100 mg                                 Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3130001003Injection, testosterone enanthate, up to 200 mg                                 Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3140001003Injection, testosterone suspension, up to 50 mg                                 Testosterone suspension inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3150001003Injection, testosterone propionate, up to 100 mg                                Testosteron propionate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3230001003Injection, chlorpromazine hcl, up to 50 mg                                      Chlorpromazine hcl injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3240001003Injection, thyrotropin alpha, 0. 9 mg, provided in 1. 1 mg vial                 Thyrotropin injection       51      A                  2049                                                                               DYY20080101                O1E 1P     01986010120030101        N
J3243001003Injection, tigecycline, 1 mg                                                    Tigecycline injection       51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J3246001003Injection, tirofiban hcl, 0. 25mg                                               Tirofiban HCl               51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J3250001003Injection, trimethobenzamide hcl, up to 200 mg                                  Trimethobenzamide hcl inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3260001003Injection, tobramycin sulfate, up to 80 mg                                      Tobramycin sulfate injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3262001003Injection, tocilizumab, 1 mg                                                    Tocilizumab injection       51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J3265001003Injection, torsemide, 10 mg/ml                                                  Injection torsemide 10 mg/ml51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J3280001003Injection, thiethylperazine maleate, up to 10 mg                                Thiethylperazine maleate inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3285001003Injection, treprostinil, 1 mg                                                   Treprostinil injection      51      A                                                                                                     CYY20080101                O1E 1P     02006010120060101        N
J3300001003Injection, triamcinolone acetonide, preservative free, 1 mg                     Triamcinolone A inj PRS-free51      A                                                                                                     DYY20090101            0127O1E 1P     02009010120090101        N
J3301001003Injection, triamcinolone  acetonide, not otherwise specified, 10 mg             Triamcinolone acet inj NOS  51      A                  2049                                                                               D                          O1E 1P     01991010120090101        N
J3302001003Injection, triamcinolone diacetate, per 5mg                                     Triamcinolone diacetate inj 51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N
J3303001003Injection, triamcinolone hexacetonide, per 5mg                                  Triamcinolone hexacetonl inj51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N
J3305001003Injection, trimetrexate glucuronate, per 25 mg                                  Inj trimetrexate glucoronate51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J3310001003Injection, perphenazine, up to 5 mg                                             Perphenazine injeciton      51      A                  2049                                                                               DYY20120101                O1E 1P     01982010119970101        N
J3315001003Injection, triptorelin pamoate, 3. 75 mg                                        Triptorelin pamoate         51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120030101        N
J3320001003Injection, spectinomycin dihydrochloride, up to 2 gm                            Spectinomycn di-hcl inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3350001003Injection, urea, up to 40 gm                                                    Urea injection              51      A                  2049                                                                               DYY20120101                O1E 1P     01986010119970101        N
J3355001003Injection, urofollitropin, 75 iu                                                Urofollitropin, 75 iu       51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N
J3357001003Injection, ustekinumab, 1 mg                                                    Ustekinumab injection       51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J3360001003Injection, diazepam, up to 5 mg                                                 Diazepam injection          51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3364001003Injection, urokinase, 5000 iu vial                                              Urokinase 5000 IU injection 51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N
J3365001003Injection, iv, urokinase, 250,000 i. U. Vial                                    Urokinase 250,000 IU inj    51      A                  2049                                                      Q0089                    DYY20080101                O1E 1P     01992010119970101        N
J3370001003Injection, vancomycin hcl, 500 mg                                               Vancomycin hcl injection    51      A60-14             2049                                                                               D                          O1E 1P     01986010120000101        N
J3385001003Injection, velaglucerase alfa, 100 units                                        Velaglucerase alfa          51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J3396001003Injection, verteporfin, 0. 1 mg                                                 Verteporfin injection       51      A                  35-100  45-30                                                                      DYY20080101                O1E 9      02005010120050101        N
J3400001003Injection, triflupromazine hcl, up to 20 mg                                     Triflupromazine hcl inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3410001003Injection, hydroxyzine hcl, up to 25 mg                                         Hydroxyzine hcl injection   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3411001003Injection, thiamine hcl, 100 mg                                                 Thiamine hcl 100 mg         51      A                                                                                                     C                          O1E 1P     02004010120040101        N
J3415001003Injection, pyridoxine hcl, 100 mg                                               Pyridoxine hcl 100 mg       51      A                                                                                                     C                          O1E 1P     02004010120040101        N
J3420001003Injection, vitamin b-12 cyanocobalamin, up  to 1000 mcg                         Vitamin b12 injection       51      A45-4              2049                                                                               D                          O1E 1P     01986010119970101        N
J3430001003Injection, phytonadione (vitamin k), per 1 mg                                   Vitamin k phytonadione inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3465001003Injection, voriconazole, 10 mg                                                  Injection, voriconazole     51      A                  2049                                                                               DYY20080101                O1E 1P     02004010120040101        N
J3470001003Injection, hyaluronidase, up to 150 units                                       Hyaluronidase injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J3471001003Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999   Ovine, up to 999 USP units  51      A                                                                                                     D                      0123O1E 1P     02006010120060101        N
J3471002004usp units)
J3472001003Injection, hyaluronidase, ovine, preservative free, per 1000 usp units          Ovine, 1000 USP units       51      A                                                                                                     D                      0123O1E 1P     02006010120060101        N
J3473001003Injection, hyaluronidase, recombinant, 1 usp unit                               Hyaluronidase recombinant   51      A                  2049                                                                               D                          O1E 1P     02007010120070101        N
J3475001003Injection, magnesium sulfate, per 500 mg                                        Inj magnesium sulfate       51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J3480001003Injection, potassium chloride, per 2 meq                                        Inj potassium chloride      51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N
J3485001003Injection, zidovudine, 10 mg                                                    Zidovudine                  51      A                  2049                                                                               D                          O1E 1P     02001010120010101        N
J3486001003Injection, ziprasidone mesylate, 10 mg                                          Ziprasidone mesylate        51      A                                                                                                     C                          O1E 1P     02004010120040101        N
J3487001003Injection, zoledronic acid (zometa), 1 mg                                       Zoledronic acid             51      A                                                                                                     CYY20080101                O1E 1P     02003010120080101        N
J3488001003Injection, zoledronic acid (reclast), 1 mg                                      Reclast injection           51      A                                                                                                     DYY20080101            0135O1E 1P     02008010120080101        N
J3490001003Unclassified drugs                                                              Drugs unclassified injection51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J3520001003Edetate disodium, per 150 mg                                                    Edetate disodium per 150 mg 00      935-64 45-20                                                                                          M                          O1E 1P     01986010119960101        N
J3530001003Nasal vaccine inhalation                                                        Nasal vaccine inhalation    51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N
J3535001003Drug administered through a metered dose inhaler                                Metered dose inhaler drug   00      9                  2050.5                                                                             M                          O1E 1P     01994010119970101        N
J3570001003Laetrile, amygdalin, vitamin b17                                                Laetrile amygdalin vit B17  00      945-10                                                                                                M                          O1E 1P     01986010119960101        N
J3590001003Unclassified biologics                                                          Unclassified biologics      51      A                                                                                                     C                          O1E 1P     02003010120030101        N
J7030001003Infusion, normal saline solution , 1000 cc                                      Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J7040001003Infusion, normal saline solution, sterile (500 ml=1 unit)                       Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N
J70420010035% dextrose/normal saline (500 ml = 1 unit)                                     5% dextrose/normal saline   51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N
J7050001003Infusion, normal saline solution , 250 cc                                       Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J70600010035% dextrose/water (500 ml = 1 unit)                                             5% dextrose/water           51      A                  2049                                                                               D                          O1E 1P     01985010119970101        N
J7070001003Infusion, d5w, 1000 cc                                                          D5w infusion                51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J7100001003Infusion, dextran 40, 500 ml                                                    Dextran 40 infusion         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J7110001003Infusion, dextran 75, 500 ml                                                    Dextran 75 infusion         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J7120001003Ringers lactate infusion, up to 1000 cc                                         Ringers lactate infusion    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N
J7130001003Hypertonic saline solution, 50 or 100 meq, 20 cc vial                           Hypertonic saline solution  51      A                  2049                                                      J7131                    D                          O1E 1P     0198401012012010120111231N
J7131001003Hypertonic saline solution, 1 ml                                                Hypertonic saline sol       51      A                  2049                                                                               D                          O1E 1P     02012010120120101        N
J7178001003Injection, human fibrinogen concentrate, 1 mg                                   Human fibrinogen conc inj   51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        A
J7180001003Injection, factor xiii (antihemophilic factor, human), 1 i. U.                  Factor XIII anti-hem factor 51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J7183001003Injection, von willebrand factor complex (human), wilate, 1 i. U. Vwf:rco       Wilate injection            51      A                  2049                                                                               DYY20120101                O1E 1      02012010120120101        N
J7184001003Injection, von willebrand factor complex (human), wilate, per 100 iu vwf:rco    Wilate injection            00      9                                                                                                     I                          O1E 1P     0201101012012010120111231N
J7185001003Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i. U. Xyntha inj                  51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J7186001003Injection, antihemophilic factor viii/von willebrand factor complex (human),    Antihemophilic viii/vwf comp51      A                  2049                                                                               DYY20090101                O1E 1P     02009010120090101        N
J7186002004per factor viii i. U.
J7187001003Injection, von willebrand factor complex (humate-p), per iu vwf:rco             Humate-P, inj               51      A                  2049                                                                               DYY20080101                O1E 1P     02007010120080101        N
J7189001003Factor viia (antihemophilic factor, recombinant), per 1 microgram               Factor viia                 51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120060101        N
J7190001003Factor viii (antihemophilic factor, human) per i. U.                            Factor viii                 51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119990101        N
J7191001003Factor viii (antihemophilic factor (porcine)), per i. U.                        Factor VIII (porcine)       51      A                  2049                                                                               D                          O1E 1P     01996010119980101        N
J7192001003Factor viii (antihemophilic factor, recombinant) per i. U. , not otherwise      Factor viii recombinant NOS 51      A                  2049                                                                               DYY20080101                O1E 1P     01994010120100101        N
J7192002004specified
J7193001003Factor ix (antihemophilic factor, purified, non-recombinant) per i. U.          Factor IX non-recombinant   51      A                  2049                                                                               DYY20080101                O1E 1P     02002010120020101        N
J7194001003Factor ix, complex, per i. U.                                                   Factor ix complex           51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119980101        N
J7195001003Factor ix (antihemophilic factor, recombinant) per i. U.                        Factor IX recombinant       51      A                  2049                                                                               DYY20080101                O1E 1P     02002010120020101        N
J7196001003Injection, antithrombin recombinant, 50 i. U.                                   Antithrombin recombinant    51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J7197001003Antithrombin iii (human), per i. U.                                             Antithrombin iii injection  51      A                  2049                                                                               DYY20100101                O1E 1P     01992010119970101        N
J7198001003Anti-inhibitor, per i. U.                                                       Anti-inhibitor              51      A45-24             2049                                                                               DYY20080101                O1E 1P     02000010120000101        N
J7199001003Hemophilia clotting factor, not otherwise classified                            Hemophilia clot factor noc  51      A45-24             2049                                                                               D                          O1E 1P     02000010120000101        N
J7300001003Intrauterine copper contraceptive                                               Intraut copper contraceptive00      9                                          1862A1                                                     S                          P6C 9      01986010119950401        N
J7302001003Levonorgestrel-releasing intrauterine contraceptive system, 52 mg               Levonorgestrel iu contracept00      9                                          1862a1                                                     S                          P6C 9      02002010120020101        N
J7303001003Contraceptive supply, hormone containing vaginal ring, each                     Contraceptive vaginal ring  00      9                                          1862.1                                                     S                          Z2  9      02004010120040101        N
J7304001003Contraceptive supply, hormone containing patch, each                            Contraceptive hormone patch 00      9                                          1862.1                                                     S                          Z2  9      02005010120050101        N
J7306001003Levonorgestrel (contraceptive) implant system, including implants and supplies  Levonorgestrel implant sys  00      9                                                                                                     I                          P6C 9      02006010120060101        N
J7307001003Etonogestrel (contraceptive) implant system, including implant and supplies     Etonogestrel implant system 00      9                                                                                                     I                          Z2  9      02008010120080101        N
J7308001003Aminolevulinic acid hcl for topical administration, 20%, single unit dosage     Aminolevulinic acid hcl top 51      A                                                                                                     CYY20080101                O1E 1      02002010120040101        N
J7308002004form (354 mg)
J7309001003Methyl aminolevulinate (mal) for topical administration, 16. 8%, 1 gram         Methyl aminolevulinate, top 51      A                                                                                                     DYY20110101            0165O1E 9      02011010120110101        N
J7310001003Ganciclovir, 4. 5 mg, long-acting implant                                       Ganciclovir long act implant51      A                  2049                                                                               DYY20080101                O1E 9      01997010119970101        N
J7311001003Fluocinolone acetonide, intravitreal implant                                    Fluocinolone acetonide implt51      A                                                                                                     CYY20080101                O1E Q      02007010120070101        N
J7312001003Injection, dexamethasone, intravitreal implant, 0. 1 mg                         Dexamethasone intra implant 51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J7315001003Mitomycin, opthalmic, 0. 2 mg                                                   Opthalmic mitomycin         51      A                                                                                                     C                          O1E 1P     02013010120130101        A
J7321001003Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection,    Hyalgan/supartz inj per dose51      A                                                                                                     CYY20080101                O1E 1      02008010120080101        N
J7321002004per dose
J7322001003Hyaluronan or derivative, synvisc, for intra-articular injection, per dose      Synvisc inj per dose        51      A                                                                                                     C                          O1E 1      0200801012010010120091231N
J7323001003Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose     Euflexxa inj per dose       51      A                                                                                                     CYY20080101                O1E 1      02008010120080101        N
J7324001003Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose    Orthovisc inj per dose      51      A                                                                                                     CYY20080101                O1E 1      02008010120080101        N
J7325001003Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular           Synvisc or Synvisc-One      51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J7325002004injection, 1 mg
J7326001003Hyaluronan or derivative, gel-one, for intra-articular injection, per dose      Gel-one                     51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N
J7330001003Autologous cultured chondrocytes, implant                                       Cultured chondrocytes implnt57      A                                                                                                     C                          O1E 1P     02001010120020701        N
J7335001003Capsaicin 8% patch, per 10 square centimeters                                   Capsaicin 8% patch          51      A                                                                                                     CYY20110101                O1E 9      02011010120110101        N
J7500002003Azathioprine, oral, 50 mg                                                       Azathioprine oral 50mg      51      A                  2049.5                                                                             D                          O1E 1G     01988010120000101        N
J7501001003Azathioprine, parenteral, 100 mg                                                Azathioprine parenteral     51      A                  2049                                                                               DYY20080101                O1E 1G     01988010120000101        N
J7502001003Cyclosporine, oral, 100 mg                                                      Cyclosporine oral 100 mg    57      A                  2049.5                                                                             D                          O1E 1G     02000010120000101        N
J7504001003Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg  Lymphocyte immune globulin  51      A45-22             2049                                                                               DYY20080101                O1E 1G     01988010120020101        N
J7505001003Muromonab-cd3, parenteral, 5 mg                                                 Monoclonal antibodies       51      A                  2049                                                                               DYY20080101                O1E 1G     01988010120010101        N
J7506001003Prednisone, oral, per 5mg                                                       Prednisone oral             51      A                  2049.5                                                                             D                          O1E 1G     01989010120000101        N
J7507001003Tacrolimus, oral, per 1 mg                                                      Tacrolimus oral per 1 MG    51      A                  2049.5                                                                             D                          O1E 1G     01995010120000101        N
J7509001003Methylprednisolone oral, per 4 mg                                               Methylprednisolone oral     51      A                  2049.5                                                                             D                          O1E 1G     01996010120000101        N
J7510001003Prednisolone oral, per 5 mg                                                     Prednisolone oral per 5 mg  51      A                  2049.5                                                                             D                          O1E 1G     01996010120000101        N
J7511001003Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25mg    Antithymocyte globuln rabbit51      A                                                                                                     CYY20080101                O1E 1G     02002010120020101        N
J7513001003Daclizumab, parenteral, 25 mg                                                   Daclizumab, parenteral      51      A                  2049.5                                                                             DYY20080101                O1E 1G     01999010120000101        N
J7515001003Cyclosporine, oral, 25 mg                                                       Cyclosporine oral 25 mg     51      A                                                                                                     C                          O1E 1G     02000010120000101        N
J7516001003Cyclosporin, parenteral, 250 mg                                                 Cyclosporin parenteral 250mg51      A                                                                                                     C                          O1E 1G     02000010120000101        N
J7517001003Mycophenolate mofetil, oral, 250 mg                                             Mycophenolate mofetil oral  51      A                                                                                                     C                          O1E 1G     02000010120000101        N
J7518001003Mycophenolic acid, oral, 180 mg                                                 Mycophenolic acid           51      A                  2050.5  4471    5249                                                               D                          O1E 1G     02005010120050101        N
J7520001003Sirolimus, oral, 1 mg                                                           Sirolimus, oral             51      A                  2049.5                                                                             D                          O1E 1G     02001010120010101        N
J7525001003Tacrolimus, parenteral, 5 mg                                                    Tacrolimus injection        51      A                  2049.5                                                                             DYY20080101                O1E 1G     02001010120010101        N
J7527001003Everolimus, oral, 0. 25 mg                                                      Oral everolimus             51      A                  2049.5                                                                             DYY20130101                O1G 1G     02013010120130101        A
J7599001003Immunosuppressive drug, not otherwise classified                                Immunosuppressive drug noc  51      A                  2049.5                                                                             D                          O1E 1G     01996010120000101        N
J7604001003Acetylcysteine, inhalation solution, compounded product, administered through   Acetylcysteine comp unit    51      A                                                                                                     C                          D1G 1P     02008010120080101        N
J7604002004dme, unit dose form, per gram
J7605001003Arformoterol, inhalation solution, fda approved final product, non-compounded,  Arformoterol non-comp unit  51      A                                                                                                     C                          D1G 1P     02008010120080101        N
J7605002004administered through dme, unit dose form, 15 micrograms
J7606001003Formoterol fumarate, inhalation solution, fda approved final product,           Formoterol fumarate, inh    51      A                                                                                                     C                          D1G 1P     02009010120090101        N
J7606002004non-compounded, administered through dme, unit dose form, 20 micrograms
J7607001003Levalbuterol, inhalation solution, compounded product, administered through     Levalbuterol comp con       51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7607002004dme, concentrated form, 0. 5 mg
J7608002003Acetylcysteine, inhalation solution, fda-approved final product,                Acetylcysteine non-comp unit51      A                                                                                                     D                      0135D1G 1P     02000010120080101        N
J7608003004non-compounded,  administered through dme, unit dose form, per gram
J7609001003Albuterol, inhalation solution, compounded product, administered through dme,   Albuterol comp unit         51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7609002004unit dose, 1 mg
J7610001003Albuterol, inhalation solution, compounded product, administered through dme,   Albuterol comp con          51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7610002004concentrated form, 1 mg
J7611001003Albuterol, inhalation solution, fda-approved final product, non-compounded,     Albuterol non-comp con      00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N
J7611002004administered through dme, concentrated form, 1 mg
J7612001003Levalbuterol, inhalation solution, fda-approved final product, non-compounded,  Levalbuterol non-comp con   00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N
J7612002004administered through dme, concentrated form, 0. 5 mg
J7613001003Albuterol, inhalation solution, fda-approved final product, non-compounded,     Albuterol non-comp unit     00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N
J7613002004administered through dme, unit dose, 1 mg
J7614001003Levalbuterol, inhalation solution, fda-approved final product, non-compounded,  Levalbuterol non-comp unit  00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N
J7614002004administered through dme, unit dose, 0. 5 mg
J7615001003Levalbuterol, inhalation solution, compounded product, administered through     Levalbuterol comp unit      51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7615002004dme, unit dose, 0. 5 mg
J7620001003Albuterol, up to 2. 5 mg and ipratropium bromide, up to 0. 5 mg, fda-approved   Albuterol ipratrop non-comp 51      A                                                                                                     D                      0135D1G 1P     02006010120070101        N
J7620002004final product, non-compounded, administered through dme
J7622001003Beclomethasone, inhalation solution, compounded product,  administered through  Beclomethasone comp unit    51      A                                                                                                     C                          D1G 1P     02002010120070101        N
J7622002004dme, unit dose form, per milligram
J7624001003Betamethasone, inhalation solution, compounded product, administered through    Betamethasone comp unit     51      A                                                                                                     C                          D1G 1P     02002010120070101        N
J7624002004dme, unit dose form, per milligram
J7626001003Budesonide, inhalation solution, fda-approved final product, non-compounded,    Budesonide non-comp unit    51      A                                                                                                     C                          D1G 1P     02002010120070101        N
J7626002004administered through dme, unit dose form, up to 0. 5 mg
J7627001003Budesonide, inhalation solution, compounded product, administered through dme,  Budesonide comp unit        51      A                                                                                                     C                          D1G 1P     02006010120070101        N
J7627002004unit dose form, up to 0. 5 mg
J7628001003Bitolterol mesylate, inhalation solution, compounded product,  administered     Bitolterol mesylate comp con51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7628002004through dme, concentrated form, per milligram
J7629001003Bitolterol mesylate, inhalation solution, compounded product,  administered     Bitolterol mesylate comp unt51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7629002004through dme, unit dose form, per milligram
J7631001003Cromolyn sodium, inhalation solution, fda-approved final product,               Cromolyn sodium noncomp unit51      A                                                                                                     D                      0135D1G 1P     02000010120080101        N
J7631002004non-compounded, administered through dme, unit dose form, per 10 milligrams
J7632001003Cromolyn sodium, inhalation solution, compounded product, administered through  Cromolyn sodium comp unit   51      A                                                                                                     C                          D1G 1P     02008010120080101        N
J7632002004dme, unit dose form, per 10 milligrams
J7633001003Budesonide, inhalation solution, fda-approved final product, non-compounded,    Budesonide non-comp con     51      A                                                                                                     C                          D1G 1P     02003010120070101        N
J7633002004administered through dme, concentrated form, per 0. 25 milligram
J7634001003Budesonide, inhalation solution, compounded product, administered through dme,  Budesonide comp con         51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7634002004concentrated form, per 0. 25 milligram
J7635001003Atropine, inhalation solution, compounded product, administered through dme,    Atropine comp con           51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7635002004concentrated form, per milligram
J7636001003Atropine, inhalation solution, compounded product, administered through dme,    Atropine comp unit          51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7636002004unit dose form, per milligram
J7637001003Dexamethasone, inhalation solution, compounded product, administered through    Dexamethasone comp con      51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7637002004dme, concentrated form, per milligram
J7638001003Dexamethasone, inhalation solution, compounded product, administered through    Dexamethasone comp unit     51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7638002004dme, unit dose form, per milligram
J7639001003Dornase alfa, inhalation solution, fda-approved final product, non-compounded,  Dornase alfa non-comp unit  51      A                                                                                                     D                      0135D1G 1P     02000010120090101        N
J7639002004administered through dme, unit dose form, per milligram
J7640001003Formoterol, inhalation solution, compounded product, administered through dme,  Formoterol comp unit        00      9                                                                                                     C                          D1G 1P     02006010120070101        N
J7640002004unit dose form, 12 micrograms
J7641001003Flunisolide, inhalation solution, compounded product, administered through dme, Flunisolide comp unit       51      A                                                                                                     C                          D1G 1P     02002010120070101        N
J7641002004unit dose, per milligram
J7642001003Glycopyrrolate, inhalation solution, compounded product, administered through   Glycopyrrolate comp con     51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7642002004dme, concentrated form, per milligram
J7643001003Glycopyrrolate, inhalation solution, compounded product, administered through   Glycopyrrolate comp unit    51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7643002004dme, unit dose form, per milligram
J7644001003Ipratropium bromide, inhalation solution, fda-approved final product,           Ipratropium bromide non-comp51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7644002004non-compounded, administered through dme, unit dose form, per milligram
J7645001003Ipratropium bromide, inhalation solution, compounded product, administered      Ipratropium bromide comp    51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7645002004through dme, unit dose form, per milligram
J7647001003Isoetharine hcl, inhalation solution, compounded product, administered through  Isoetharine comp con        51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7647002004dme, concentrated form, per milligram
J7648001003Isoetharine hcl, inhalation solution, fda-approved final product,               Isoetharine non-comp con    51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7648002004non-compounded, administered through dme, concentrated form, per milligram
J7649001003Isoetharine hcl, inhalation solution, fda-approved final product,               Isoetharine non-comp unit   51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7649002004non-compounded, administered through dme, unit dose form, per milligram
J7650001003Isoetharine hcl, inhalation solution, compounded product, administered through  Isoetharine comp unit       51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7650002004dme, unit dose form, per milligram
J7657001003Isoproterenol hcl, inhalation solution, compounded product, administered        Isoproterenol comp con      51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7657002004through dme, concentrated form, per milligram
J7658001003Isoproterenol hcl, inhalation solution, fda-approved final product,             Isoproterenol non-comp con  51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7658002004non-compounded, administered through dme, concentrated form, per milligram
J7659001003Isoproterenol hcl, inhalation solution, fda-approved final product,             Isoproterenol non-comp unit 51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7659002004non-compounded, administered through dme, unit dose form, per milligram
J7660001003Isoproterenol hcl, inhalation solution, compounded product, administered        Isoproterenol comp unit     51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7660002004through dme, unit dose form, per milligram
J7665001003Mannitol, administered through an inhaler, 5 mg                                 Mannitol for inhaler        51      A                                                                                                     C                          O1E 1      02012010120130101        T
J7667001003Metaproterenol sulfate, inhalation solution, compounded product, concentrated   Metaproterenol comp con     51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7667002004form, per 10 milligrams
J7668001003Metaproterenol sulfate, inhalation solution, fda-approved final product,        Metaproterenol non-comp con 51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7668002004non-compounded, administered through dme, concentrated form, per 10 milligrams
J7669001003Metaproterenol sulfate, inhalation solution, fda-approved final product,        Metaproterenol non-comp unit51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7669002004non-compounded, administered through dme, unit dose form, per 10 milligrams
J7670001003Metaproterenol sulfate, inhalation solution, compounded product, administered   Metaproterenol comp unit    51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7670002004through dme, unit dose form, per 10 milligrams
J7674001003Methacholine chloride administered as inhalation solution through a nebulizer,  Methacholine chloride, neb  51      A                                                                                                     C                          O1E 1P     02005010120050101        N
J7674002004per 1 mg
J7676001003Pentamidine isethionate, inhalation solution, compounded product, administered  Pentamidine comp unit dose  51      A                                                                                                     C                          D1G 1P     02008010120080101        N
J7676002004through dme, unit dose form, per 300 mg
J7680001003Terbutaline sulfate, inhalation solution, compounded product, administered      Terbutaline sulf comp con   51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7680002004through dme, concentrated form, per milligram
J7681001003Terbutaline sulfate, inhalation solution, compounded product, administered      Terbutaline sulf comp unit  51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7681002004through dme, unit dose form, per milligram
J7682001003Tobramycin, inhalation solution, fda-approved final product, non-compounded,    Tobramycin non-comp unit    51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7682002004unit dose form, administered through dme, per 300 milligrams
J7683001003Triamcinolone, inhalation solution, compounded product, administered through    Triamcinolone comp con      51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7683002004dme, concentrated form, per milligram
J7684001003Triamcinolone, inhalation solution, compounded product, administered through    Triamcinolone comp unit     51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N
J7684002004dme, unit dose form, per milligram
J7685001003Tobramycin, inhalation solution, compounded product, administered through dme,  Tobramycin comp unit        51      A                                                                                                     C                          D1G 1P     02007010120070101        N
J7685002004unit dose form, per 300 milligrams
J7686001003Treprostinil, inhalation solution, fda-approved final product, non-compounded,  Treprostinil, non-comp unit 51      A                                                                                                     C                          D1G 1P     02011010120110101        N
J7686002004administered through dme, unit dose form, 1. 74 mg
J7699001003Noc drugs, inhalation solution administered through dme                         Inhalation solution for DME 51      A                                                                                                     D                      0135D1G 1P     01993010120070101        N
J7799001003Noc drugs, other than inhalation drugs, administered through dme                Non-inhalation drug for DME 51      A                  2100.5                                                                             D                          D1G 1P     01993010120020701        N
J8498001003Antiemetic drug, rectal/suppository, not otherwise specified                    Antiemetic rectal/supp NOS  51      A                                          1861s2T                                                    D                          O1D 1      02006010120060101        N
J8499001003Prescription drug, oral, non chemotherapeutic, nos                              Oral prescrip drug non chemo00      9                  2049                                                                               M                          O1E 1P     01995010119970101        N
J8501001003Aprepitant, oral, 5 mg                                                          Oral aprepitant             51      A                                                                                                     DYY20080101            0119O1E 1G     02005010120050101        N
J8510003003Busulfan; oral, 2 mg                                                            Oral busulfan               51      A                  2049.5                                                                             DYY20110101                O1D 1P     02000010120000101        N
J8515001003Cabergoline, oral, 0. 25 mg                                                     Cabergoline, oral 0.25mg    00      9                  2049.5                                                                             M                          O1E 1P     02006010120060101        N
J8520001003Capecitabine, oral, 150 mg                                                      Capecitabine, oral, 150 mg  51      A                  2049.5                                                                             DYY20080101                O1D 1P     02000010120000101        N
J8521001003Capecitabine, oral, 500 mg                                                      Capecitabine, oral, 500 mg  51      A                  2049.5                                                                             DYY20080101                O1D 1P     02000010120000101        N
J8530001003Cyclophosphamide; oral, 25 mg                                                   Cyclophosphamide oral 25 MG 51      A                  2049.5                                                                             D                          O1D 1GP    01995010119970831        N
J8540001003Dexamethasone, oral, 0. 25 mg                                                   Oral dexamethasone          51      A                                          1861(s)2T                                                  D                          O1E 1      02006010120060101        N
J8560001003Etoposide; oral, 50 mg                                                          Etoposide oral 50 MG        51      A                  2049.5                                                                             DYY20080101                O1D 1P     01995010119970101        N
J8561001003Everolimus, oral, 0. 25 mg                                                      Oral everolimus             51      A                  2049.5                                                                             D                          O1E 1G     0201201012013010120121231D
J8562001003Fludarabine phosphate, oral, 10 mg                                              Oral fludarabine phosphate  51      A                                                                                                     CYY20110101                O1D 9      02011010120110101        N
J8565001003Gefitinib, oral, 250 mg                                                         Gefitinib oral              00      9                                                                                                     I                          O1E 9      02005010120050101        N
J8597001003Antiemetic drug, oral, not otherwise specified                                  Antiemetic drug oral NOS    51      A                                          1861s2T                                                    D                          O1D 1      02006010120060101        N
J8600001003Melphalan; oral, 2 mg                                                           Melphalan oral 2 MG         51      A                  2049.5                                                                             D                          O1D 1P     01995010119970101        N
J8610001003Methotrexate; oral, 2. 5 mg                                                     Methotrexate oral 2.5 MG    51      A                  2049.5                                                                             D                          O1D 1GP    01995010119970831        N
J8650001003Nabilone, oral, 1 mg                                                            Nabilone oral               51      A                                                                                                     CYY20130101                O1E 1G     02007010120070101        N
J8700001003Temozolomide, oral, 5 mg                                                        Temozolomide                51      A                  2049.5C                                                                            DYY20080101                O1D 1P     02001010120010101        N
J8705001003Topotecan, oral, 0. 25 mg                                                       Topotecan oral              51      A                                                                                                     CYY20090101                O1D 1P     02009010120090101        N
J8999001003Prescription drug, oral, chemotherapeutic, nos                                  Oral prescription drug chemo51      A                  2049.5                                                                             D                          O1D 1P     01995010119970101        N
J9000004003Injection, doxorubicin hydrochloride, 10 mg                                     Doxorubicin hcl injection   51      A                  2049                                                                               D                          O1D 1P     01984010120090101        N
J9001001003Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg             Doxorubicin hcl liposome inj00      9                                                                                                     I                          O1E 1P     0200001012013010120121231D
J9002001003Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg                   Doxil injection             51      A                  2049                                                                               DYY20130101                O1D P      02013010120130101        A
J9010001003Injection, alemtuzumab, 10 mg                                                   Alemtuzumab injection       51      A                                          1833T                                                      DYY20080101                O1E 1P     02003010120090101        N
J9015001003Injection, aldesleukin, per single use vial                                     Aldesleukin injection       51      A                  2049                                                                               DYY20080101                O1D 1P     01996010120090101        N
J9017001003Injection, arsenic trioxide, 1 mg                                               Arsenic trioxide injection  51      A                                                                                                     CYY20080101                O1D 1P     02002010120090101        N
J9019001003Injection, asparaginase (erwinaze), 1,000 iu                                    Erwinaze injection          51      A                  2049                                                                               DYY20130101                O1D 1P     02013010120130101        A
J9020001003Injection, asparaginase, not otherwise specified, 10,000 units                  Asparaginase, NOS           51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120130101        C
J9025001003Injection, azacitidine, 1 mg                                                    Azacitidine injection       51      A                                                                                                     CYY20080101                O1D 1P     02006010120060101        N
J9027001003Injection, clofarabine, 1 mg                                                    Clofarabine injection       51      A                                                                                                     CYY20080101                O1E 1P     02006010120060101        N
J9031001003Bcg (intravesical) per instillation                                             Bcg live intravesical vac   51      A                  2049                                                                               DYY20080101                O1D 1P     01991010119970101        N
J9033001003Injection, bendamustine hcl, 1 mg                                               Bendamustine injection      51      A                                                                                                     CYY20090101                O1D 1P     02009010120090101        N
J9035001003Injection, bevacizumab, 10 mg                                                   Bevacizumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J9040001003Injection, bleomycin sulfate, 15 units                                          Bleomycin sulfate injection 51      A                  2049                                                                               D                          O1D 1P     01984010120090101        N
J9041001003Injection, bortezomib, 0. 1 mg                                                  Bortezomib injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J9042001003Injection, brentuximab vedotin, 1 mg                                            Brentuximab vedotin inj     51      A                                                                                                     CYY20130101                O1D 1P     02013010120130101        A
J9043001003Injection, cabazitaxel, 1 mg                                                    Cabazitaxel injection       51      A                                                                                                     CYY20120101                O1D 1P     02012010120120101        N
J9045001003Injection, carboplatin, 50 mg                                                   Carboplatin injection       51      A                  2049                                                                               D                          O1D 1P     01990010120090101        N
J9050001003Injection, carmustine, 100 mg                                                   Carmustine injection        51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120090101        N
J9055001003Injection, cetuximab, 10 mg                                                     Cetuximab injection         51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J9060001003Injection, cisplatin, powder or solution, 10 mg                                 Cisplatin 10 MG injection   51      A                  2049                                                                               D                          O1D 1P     01984010120110101        N
J9062001003Cisplatin, 50 mg                                                                Cisplatin 50 MG injection   51      A                  2049                                                                               D                          O1D 1P     0198201012011010120101231N
J9065001003Injection, cladribine, per 1 mg                                                 Inj cladribine per 1 MG     51      A                  2049                                                                               DYY20080101                O1D 1P     01995010119970101        N
J9070001003Cyclophosphamide, 100 mg                                                        Cyclophosphamide 100 MG inj 51      A                  2049                                                                               DYY20120101                O1D 1P     01984010119970101        N
J9080001003Cyclophosphamide, 200 mg                                                        Cyclophosphamide 200 MG inj 51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9090001003Cyclophosphamide, 500 mg                                                        Cyclophosphamide 500 MG inj 51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9091001003Cyclophosphamide, 1. 0 gram                                                     Cyclophosphamide 1.0 grm inj51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9092001003Cyclophosphamide, 2. 0 gram                                                     Cyclophosphamide 2.0 grm inj51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9093001003Cyclophosphamide, lyophilized, 100 mg                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     0198801012011010120101231N
J9094001003Cyclophosphamide, lyophilized, 200 mg                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9095001003Cyclophosphamide, lyophilized, 500 mg                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9096001003Cyclophosphamide, lyophilized, 1. 0 gram                                        Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9097001003Cyclophosphamide, lyophilized, 2. 0 gram                                        Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9098001003Injection, cytarabine liposome, 10 mg                                           Cytarabine liposome inj     51      A                                                                                                     CYY20080101                O1E 1P     02004010120090101        N
J9100001003Injection, cytarabine, 100 mg                                                   Cytarabine hcl 100 MG inj   51      A                  2049                                                                               D                          O1D 1P     01986010120090101        N
J9110001003Injection, cytarabine, 500 mg                                                   Cytarabine hcl 500 MG inj   51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9120001003Injection, dactinomycin, 0. 5 mg                                                Dactinomycin injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120090101        N
J9130001003Dacarbazine, 100 mg                                                             Dacarbazine 100 mg inj      51      A                  2049                                                                               D                          O1D 1P     01986010120040101        N
J9140001003Dacarbazine, 200 mg                                                             Dacarbazine 200 MG inj      51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9150001003Injection, daunorubicin, 10 mg                                                  Daunorubicin injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120090101        N
J9151001003Injection, daunorubicin citrate, liposomal formulation, 10 mg                   Daunorubicin citrate inj    51      A                  2049                                                                               DYY20080101                O1D 1P     01999010120090101        N
J9155001003Injection, degarelix, 1 mg                                                      Degarelix injection         51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
J9160001003Injection, denileukin diftitox, 300 micrograms                                  Denileukin diftitox inj     51      A                                                                                                     CYY20080101                O1E 1P     02001010120090101        N
J9165001003Injection, diethylstilbestrol diphosphate, 250 mg                               Diethylstilbestrol injection51      A                  2049                                                                               D                          O1D 1P     01988010120090101        N
J9170001003Injection, docetaxel, 20 mg                                                     Docetaxel injection         51      A                  2049                                                                               D                          O1D 1P     0199801012010010120091231N
J9171001003Injection, docetaxel, 1 mg                                                      Docetaxel injection         51      A                  2049                                                                               DYY20100101                O1E 1P     02010010120100101        N
J9175001003Injection, elliotts' b solution, 1 ml                                           Elliotts b solution per ml  51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        N
J9178001003Injection, epirubicin hcl, 2 mg                                                 Inj, epirubicin hcl, 2 mg   51      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N
J9179001003Injection, eribulin mesylate, 0. 1 mg                                           Eribulin mesylate injection 51      A                                                                                                     CYY20120101                O1D 1P     02012010120120101        N
J9181001003Injection, etoposide, 10 mg                                                     Etoposide injection         51      A                  2049                                                                               D                          O1D 1P     01987010120090101        N
J9185001003Injection, fludarabine phosphate, 50 mg                                         Fludarabine phosphate inj   51      A                  2049                                                                               DYY20080101                O1D 1P     01994010120090101        N
J9190001003Injection, fluorouracil, 500 mg                                                 Fluorouracil injection      51      A                  2049                                                                               D                          O1D 1P     01984010120090101        N
J9200001003Injection, floxuridine, 500 mg                                                  Floxuridine injection       51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120090101        N
J9201001003Injection, gemcitabine hydrochloride, 200 mg                                    Gemcitabine hcl injection   51      A                  2049                                                                               DYY20080101                O1D 1P     01998010120090101        N
J9202001003Goserelin acetate implant, per 3. 6 mg                                          Goserelin acetate implant   51      A                  2049                                                                               DYY20080101                O1D 1P     01991010119970101        N
J9206001003Injection, irinotecan, 20 mg                                                    Irinotecan injection        51      A                  2049                                                                               D                          O1D 1P     01998010120090101        N
J9207001003Injection, ixabepilone, 1 mg                                                    Ixabepilone injection       51      A                                                                                                     CYY20090101                O1D 1P     02009010120090101        N
J9208001003Injection, ifosfamide, 1 gram                                                   Ifosfamide injection        51      A                  2049                                                                               DYY20080101                O1D 1P     01990010120120101        N
J9209001003Injection, mesna, 200 mg                                                        Mesna injection             51      A                  2049                                                                               D                          O1D 1P     01990010120090101        N
J9211001003Injection, idarubicin hydrochloride, 5 mg                                       Idarubicin hcl injection    51      A                  2049                                                                               DYY20080101                O1D 1P     01993010120090101        N
J9212001003Injection, interferon alfacon-1, recombinant, 1 microgram                       Interferon alfacon-1 inj    51      A                  2049                                                                               DYY20130101                O1E 1P     01999010120090101        N
J9213001003Injection, interferon, alfa-2a, recombinant, 3 million units                    Interferon alfa-2a inj      51      A                  2049                                                                               D                          O1D G      01993010120090101        N
J9214001003Injection, interferon, alfa-2b, recombinant, 1 million units                    Interferon alfa-2b inj      51      A                  2049                                                                               DYY20080101                O1D G      01993010120090101        N
J9215001003Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu           Interferon alfa-n3 inj      51      A                  2049                                                                               D                          O1D G      01993010120090101        N
J9216001003Injection, interferon, gamma 1-b, 3 million units                               Interferon gamma 1-b inj    51      A                  2049                                                                               DYY20080101                O1D G      01993010120090101        N
J9217001003Leuprolide acetate (for depot suspension), 7. 5 mg                              Leuprolide acetate suspnsion51      A                  2049                                                                               DYY20080101                O1D 1P     01991010119970101        N
J9218001003Leuprolide acetate, per 1 mg                                                    Leuprolide acetate injeciton51      A                  2049                                                                               DYY20080101            0014O1D 1P     01990010119970101        N
J9219001003Leuprolide acetate implant, 65 mg                                               Leuprolide acetate implant  51      A                  2049                                                                               DYY20080101                O1D 1P     02001010120010101        N
J9225001003Histrelin implant (vantas), 50 mg                                               Vantas implant              51      A                  2049                                                                               DYY20080101                O1D 1P     02006010120080101        N
J9226001003Histrelin implant (supprelin la), 50 mg                                         Supprelin LA implant        51      A                  2049                                                                               DYY20080101                O1D 1P     02008010120080101        N
J9228001003Injection, ipilimumab, 1 mg                                                     Ipilimumab injection        51      A                                                                                                     CYY20120101                O1D 1P     02012010120120101        N
J9230001003Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg             Mechlorethamine hcl inj     51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120090101        N
J9245001003Injection, melphalan hydrochloride, 50 mg                                       Inj melphalan hydrochl 50 MG51      A                  2049                                                                               DYY20080101                O1D 1P     01995010119970101        N
J9250001003Methotrexate sodium, 5 mg                                                       Methotrexate sodium inj     51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N
J9260001003Methotrexate sodium, 50 mg                                                      Methotrexate sodium inj     51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N
J9261001003Injection, nelarabine, 50 mg                                                    Nelarabine injection        51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N
J9263001003Injection, oxaliplatin, 0. 5 mg                                                 Oxaliplatin                 51      A                                                                                                     CYY20080101                O1D 1P     02004010120040101        N
J9264001003Injection, paclitaxel protein-bound particles, 1 mg                             Paclitaxel protein bound    51      A                                                                                                     CYY20080101                O1E 1P     02006010120070101        N
J9265001003Injection, paclitaxel, 30 mg                                                    Paclitaxel injection        51      A                  2049                                                                               D                          O1D 1P     01994010120090101        N
J9266001003Injection, pegaspargase, per single dose vial                                   Pegaspargase injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01996010120090101        N
J9268001003Injection, pentostatin, 10 mg                                                   Pentostatin injection       51      A                  2049                                                                               DYY20080101                O1D 1P     01994010120090101        N
J9270001003Injection, plicamycin, 2. 5 mg                                                  Plicamycin (mithramycin) inj51      A                  2049                                                                               D                          O1D 1P     01984010120090101        N
J9280001003Injection, mitomycin, 5 mg                                                      Mitomycin injection         51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120130101        C
J9290001003Mitomycin, 20 mg                                                                Mitomycin 20 MG inj         51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9291001003Mitomycin, 40 mg                                                                Mitomycin 40 MG inj         51      A                  2049                                                                               D                          O1D 1P     0198901012011010120101231N
J9293001003Injection, mitoxantrone hydrochloride, per 5 mg                                 Mitoxantrone hydrochl / 5 MG51      A                  2049                                                                               DYY20080101                O1D 1P     01990010119970101        N
J9300001003Injection, gemtuzumab ozogamicin, 5 mg                                          Gemtuzumab ozogamicin inj   51      A                                                                                                     CYY20080101                O1D 1P     02002010120090101        N
J9302001003Injection, ofatumumab, 10 mg                                                    Ofatumumab injection        51      A                                                                                                     CYY20110101                O1D 1P     02011010120110101        N
J9303001003Injection, panitumumab, 10 mg                                                   Panitumumab injection       51      A                                                                                                     CYY20080101                O1D 1P     02008010120080101        N
J9305001003Injection, pemetrexed, 10 mg                                                    Pemetrexed injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N
J9307001003Injection, pralatrexate, 1 mg                                                   Pralatrexate injection      51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N
J9310001003Injection, rituximab, 100 mg                                                    Rituximab injection         51      A                  2049                                                                               DYY20080101                O1D 1P     01999010120090101        N
J9315001003Injection, romidepsin, 1 mg                                                     Romidepsin injection        51      A                                                                                                     CYY20110101                O1D 1P     02011010120110101        N
J9320001003Injection, streptozocin, 1 gram                                                 Streptozocin injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120090101        N
J9328001003Injection, temozolomide, 1 mg                                                   Temozolomide injection      51      A                                                                                                     CYY20100101                O1D 1P     02010010120100101        N
J9330001003Injection, temsirolimus, 1 mg                                                   Temsirolimus injection      51      A                                                                                                     CYY20090101                O1D 1P     02009010120090101        N
J9340001003Injection, thiotepa, 15 mg                                                      Thiotepa injection          51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120090101        N
J9350001003Injection, topotecan, 4 mg                                                      Topotecan injection         51      A                  2049                                                                               D                          O1D 1P     0199801012011010120101231N
J9351001003Injection, topotecan, 0. 1 mg                                                   Topotecan injection         51      A                                                                                                     CYY20110101                O1D 1P     02011010120110101        N
J9355001003Injection, trastuzumab, 10 mg                                                   Trastuzumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02000010120090101        N
J9357001003Injection, valrubicin, intravesical, 200 mg                                     Valrubicin injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02000010120090101        N
J9360001003Injection, vinblastine sulfate, 1 mg                                            Vinblastine sulfate inj     51      A                  2049                                                                               D                          O1D 1P     01986010120090101        N
J9370001003Vincristine sulfate, 1 mg                                                       Vincristine sulfate 1 MG inj51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N
J9375001003Vincristine sulfate, 2 mg                                                       Vincristine sulfate 2 MG inj51      A                  2049                                                                               D                          O1D 1P     0198801012011010120101231N
J9380001003Vincristine sulfate, 5 mg                                                       Vincristine sulfate 5 MG inj51      A                  2049                                                                               D                          O1D 1P     0199401012011010120101231N
J9390001003Injection, vinorelbine tartrate, 10 mg                                          Vinorelbine tartrate inj    51      A                  2049                                                                               D                          O1D 1P     01996010120090101        N
J9395001003Injection, fulvestrant, 25 mg                                                   Injection, Fulvestrant      51      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N
J9600001003Injection, porfimer sodium, 75 mg                                               Porfimer sodium injection   51      A                  2049                                                                               DYY20080101                O1D 1P     01998010120090101        N
J9999001003Not otherwise classified, antineoplastic drugs                                  Chemotherapy drug           51      A45-16             2049                                                                               D                          O1D 1P     01986010119970101        N
K0001003003Standard wheelchair                                                             Standard wheelchair         36      A                                                                                                     C                          D1D R      01994010119940101        N
K0002001003Standard hemi (low seat) wheelchair                                             Stnd hemi (low seat) whlchr 36      A                                                                                                     C                          D1D R      01994010119940101        N
K0003001003Lightweight wheelchair                                                          Lightweight wheelchair      36      A                                                                                                     C                          D1D R      01994010119940101        N
K0004001003High strength, lightweight wheelchair                                           High strength ltwt whlchr   36      A                                                                                                     C                          D1D R      01994010119940101        N
K0005001003Ultralightweight wheelchair                                                     Ultralightweight wheelchair 32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0006001003Heavy duty wheelchair                                                           Heavy duty wheelchair       36      A                                                                                                     C                          D1D R      01994010119940101        N
K0007001003Extra heavy duty wheelchair                                                     Extra heavy duty wheelchair 36      A                                                                                                     C                          D1D R      01994010119940101        N
K0009001003Other manual wheelchair/base                                                    Other manual wheelchair/base46      A                                                                                                     C                          D1D APR    01994010119940101        N
K0010001003Standard - weight frame motorized/power wheelchair                              Stnd wt frame power whlchr  36      A                                                                                                     C                          D1D APR    01994010119970505        N
K0011001003Standard - weight frame motorized/power wheelchair with programmable control    Stnd wt pwr whlchr w control36      A                                                                                                     C                          D1D APR    01994010119970505        N
K0011002004parameters for speed adjustment, tremor dampening, acceleration control and
K0011003004braking
K0012001003Lightweight portable motorized/power wheelchair                                 Ltwt portbl power whlchr    36      A                                                                                                     C                          D1D APR    01994010119970505        N
K0014001003Other motorized/power wheelchair base                                           Other power whlchr base     36      A                                                                                                     C                          D1D APR    01994010120010101        N
K0015001003Detachable, non-adjustable height armrest, each                                 Detach non-adjus hght armrst32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0017001003Detachable, adjustable height armrest, base, each                               Detach adjust armrest base  32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0018001003Detachable, adjustable height armrest, upper portion, each                      Detach adjust armrst upper  32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0019001003Arm pad, each                                                                   Arm pad each                32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0020001003Fixed, adjustable height armrest, pair                                          Fixed adjust armrest pair   32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0037001003High mount flip-up footrest, each                                               High mount flip-up footrest 32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0038001003Leg strap, each                                                                 Leg strap each              32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0039001003Leg strap, h style, each                                                        Leg strap h style each      32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0040001003Adjustable angle footplate, each                                                Adjustable angle footplate  32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0041001003Large size footplate, each                                                      Large size footplate each   32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0042001003Standard size footplate, each                                                   Standard size footplate each32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0043001003Footrest, lower extension tube, each                                            Ftrst lower extension tube  32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0044001003Footrest, upper hanger bracket, each                                            Ftrst upper hanger bracket  32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0045001003Footrest, complete assembly                                                     Footrest complete assembly  32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0046001003Elevating legrest, lower extension tube, each                                   Elevat legrst low extension 32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0047001003Elevating legrest, upper hanger bracket, each                                   Elevat legrst up hangr brack32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0050001003Ratchet assembly                                                                Ratchet assembly            32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0051001003Cam release assembly, footrest or legrest, each                                 Cam relese assem ftrst/lgrst32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0052001003Swingaway, detachable footrests, each                                           Swingaway detach footrest   32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0053001003Elevating footrests, articulating (telescoping), each                           Elevate footrest articulate 32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0056001003Seat height less than  17" or equal to  or greater than 21" for a high          Seat ht <17 or >=21 ltwt wc 32      A                                                                                                     C                          D1D APR    01994010119990101        N
K0056002004strength, lightweight, or ultralightweight wheelchair
K0065001003Spoke protectors, each                                                          Spoke protectors            32      A                                                                                                     C                          D1D APR    01994010120000101        N
K0069001003Rear wheel assembly, complete, with solid tire, spokes or molded, each          Rear whl complete solid tire32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0070001003Rear wheel assembly, complete, with pneumatic tire, spokes or molded, each      Rear whl compl pneum tire   32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0071001003Front caster assembly, complete, with pneumatic tire, each                      Front castr compl pneum tire32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0072001003Front caster assembly, complete, with semi-pneumatic tire, each                 Frnt cstr cmpl sem-pneum tir32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0073001003Caster pin lock,each                                                            Caster pin lock each        32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0077001003Front caster assembly, complete, with solid tire, each                          Front caster assem complete 32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0098001003Drive belt for power wheelchair                                                 Drive belt power wheelchair 32      A                                                                                                     C                          D1D APR    01994010119940101        N
K0105001003Iv hanger, each                                                                 Iv hanger                   32      A                                                                                                     C                          D1D APR    01994010120000101        N
K0108001003Wheelchair component or accessory, not otherwise specified                      W/c component-accessory NOS 46      A                                                                                                     C                          D1D APR    01994010119990701        N
K0195001003Elevating leg rests, pair (for use with capped rental wheelchair base)          Elevating whlchair leg rests36      A60-9                                                                                                 D                          D1D R      01993010119930101        N
K0455001003Infusion pump used for uninterrupted parenteral administration of medication,   Pump uninterrupted infusion 31      A60-14                                                                                                D                          D1E R      01998010120030701        N
K0455002004(e. G. , epoprostenol or treprostinol)
K0462001003Temporary replacement for patient owned equipment being repaired, any type      Temporary replacement eqpmnt32      A                  5102.3                                                                             D                          D1E 9      01998070119980701        N
K0552001003Supplies for external drug infusion pump, syringe type cartridge, sterile, each Supply/ext inf pump syr type34      A60-14                                                                                                D                          D1E P      02003070120030701        N
K0601001003Replacement battery for external infusion pump owned by patient, silver oxide,  Repl batt silver oxide 1.5 v32      A                                                                                                     C                          D1E APR    02003040120030401        N
K06010020041. 5 volt, each
K0602001003Replacement battery for external infusion pump owned by patient, silver oxide,  Repl batt silver oxide 3 v  32      A                                                                                                     C                          D1E APR    02003040120030401        N
K06020020043 volt, each
K0603001003Replacement battery for external infusion pump owned by patient, alkaline, 1. 5 Repl batt alkaline 1.5 v    32      A                                                                                                     C                          D1E APR    02003040120030401        N
K0603002004volt, each
K0604001003Replacement battery for external infusion pump owned by patient, lithium, 3. 6  Repl batt lithium 3.6 v     32      A                                                                                                     C                          D1E APR    02003040120030401        N
K0604002004volt, each
K0605001003Replacement battery for external infusion pump owned by patient, lithium, 4. 5  Repl batt lithium 4.5 v     32      A                                                                                                     C                          D1E APR    02003040120030401        N
K0605002004volt, each
K0606001003Automatic external defibrillator, with integrated electrocardiogram analysis,   AED garment w elec analysis 36      A                                                                                                     C                          D1E APR    02003070120030701        N
K0606002004garment type
K0607001003Replacement battery for automated external defibrillator, garment type only,    Repl batt for AED           32      A                                                                                                     C                          D1E APR    02003070120030701        N
K0607002004each
K0608001003Replacement garment for use with automated external defibrillator, each         Repl garment for AED        32      A                                                                                                     C                          D1E APR    02003070120030701        N
K0609001003Replacement electrodes for use with automated external defibrillator, garment   Repl electrode for AED      34      A                                                                                                     C                          D1E P      02003070120030701        N
K0609002004type only, each
K0669001003Wheelchair accessory, wheelchair seat or back cushion, does not meet specific   Seat/back cus no dmepdac ver32      A                                                                                                     C                          D1D APR    02004070120100701        N
K0669002004code criteria or no written coding verification from dme pdac
K0672001003Addition to lower extremity orthosis, removable soft interface, all components, Removable soft interface LE 38      A                                                                                                     C                          D1F P      02008040120080401        N
K0672002004replacement only, each
K0730001003Controlled dose inhalation drug delivery system                                 Ctrl dose inh drug deliv sys32      A                                                                                                     C                          D1E R      02005070120080101        N
K0733001003Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each    12-24hr sealed lead acid    32      A                                                                                                     C                          D1D APR    02006070120060701        N
K0733002004(e. G. , gel cell, absorbed glassmat)
K0734001003Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, Adj skin pro w/c cus wd<22in32      A                                                                            E2622                    C                          D1D APR    0200607012011010120101231N
K0734002004any depth
K0735001003Skin protection wheelchair seat cushion, adjustable, width 22 inches or         Adj skin pro wc cus wd>=22in32      A                                                                            E2623                    C                          D1D APR    0200607012011010120101231N
K0735002004greater, any depth
K0736001003Skin protection and positioning wheelchair seat cushion, adjustable, width less Adj skin pro/pos wc cus<22in32      A                                                                            E2624                    C                          D1D APR    0200607012011010120101231N
K0736002004than 22 inches, any depth
K0737001003Skin protection and positioning wheelchair seat cushion, adjustable, width 22   Adj skin pro/pos wc cus>=22"32      A                                                                            E2625                    C                          D1D APR    0200607012011010120101231N
K0737002004inches or greater, any depth
K0738001003Portable gaseous oxygen system, rental; home compressor used to fill portable   Portable gas oxygen system  33      A                                                                                                     C                          D1C PR     02006100120061001        N
K0738002004oxygen cylinders; includes portable containers, regulator, flowmeter,
K0738003004humidifier, cannula or mask, and tubing
K0739001003Repair or nonroutine service for durable medical equipment other than oxygen    Repair/svc DME non-oxygen eq46      A                                                                                                     C                          D1E 9      02009040120090401        N
K0739002004equipment requiring the skill of a technician, labor component, per 15 minutes
K0740001003Repair or nonroutine service for oxygen equipment requiring the skill of a      Repair/svc oxygen equipment 00      9                                                                                                     M                      0157D1C 9      02009040120090401        N
K0740002004technician, labor component, per 15 minutes
K0741001003Portable gaseous oxygen system, rental, includes portable container, regulator, Portable gaseous oxygen sys 33      A                                                                                                     D                      0176D1C PR     0201107012013010120121231D
K0741002004flowmeter, humidifier, cannula or mask, and tubing, for cluster headaches
K0742001003Portable oxygen contents, gaseous, 1 month's supply = 1 unit, for cluster       Portable gaseous oxygen     33      A                                                                                                     D                      0176D1C P      0201107012013010120121231D
K0742002004headaches, for initial months supply or to replace used contents
K0743001003Suction pump, home model, portable, for use on wounds                           Portable home suction pump  36      A                                                                                                     C                          D1E R      02011070120110701        N
K0744001003Absorptive wound dressing for use with suction pump, home model, portable, pad  Absorp drg <= 16 suc pump   34      A                                                                                                     C                          D1E S      02011070120110701        N
K0744002004size 16 square inches or less
K0745001003Absorptive wound dressing for use with suction pump, home model, portable, pad  Absorp drg >16<=48 suc pump 34      A                                                                                                     C                          D1E S      02011070120110701        N
K0745002004size more than 16 square inches but less than or equal to 48 square inches
K0746001003Absorptive wound dressing for use with suction pump, home model, portable, pad  Absorp drg >48 suc pump     34      A                                                                                                     C                          D1E S      02011070120110701        N
K0746002004size greater than 48 square inches
K0800001003Power operated vehicle, group 1 standard, patient weight capacity up to and     POV group 1 std up to 300lbs32      A                                                                                                     C                          D1D APR    02006100120061001        N
K0800002004including 300 pounds
K0801001003Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450  POV group 1 hd 301-450 lbs  32      A                                                                                                     C                          D1D APR    02006100120061001        N
K0801002004pounds
K0802001003Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to POV group 1 vhd 451-600 lbs 32      A                                                                                                     C                          D1D APR    02006100120061001        N
K0802002004600 pounds
K0806001003Power operated vehicle, group 2 standard, patient weight capacity up to and     POV group 2 std up to 300lbs32      A                                                                                                     C                          D1D APR    02006100120061001        N
K0806002004including 300 pounds
K0807001003Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450  POV group 2 hd 301-450 lbs  32      A                                                                                                     C                          D1D APR    02006100120061001        N
K0807002004pounds
K0808001003Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to POV group 2 vhd 451-600 lbs 32      A                                                                                                     C                          D1D APR    02006100120061001        N
K0808002004600 pounds
K0812001003Power operated vehicle, not otherwise classified                                Power operated vehicle NOC  32      A                                                                                                     C                          D1D APR    02006100120061001        N
K0813001003Power wheelchair, group 1 standard, portable, sling/solid seat and back,        PWC gp 1 std port seat/back 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0813002004patient weight capacity up to and including 300 pounds
K0814001003Power wheelchair, group 1 standard, portable, captains chair, patient weight    PWC gp 1 std port cap chair 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0814002004capacity up to and including 300 pounds
K0815001003Power wheelchair, group 1 standard, sling/solid seat and back, patient weight   PWC gp 1 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0815002004capacity up to and including 300 pounds
K0816001003Power wheelchair, group 1 standard, captains chair, patient weight capacity up  PWC gp 1 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0816002004to and including 300 pounds
K0820001003Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient    PWC gp 2 std port seat/back 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0820002004weight capacity up to and including 300 pounds
K0821001003Power wheelchair, group 2 standard, portable, captains chair, patient weight    PWC gp 2 std port cap chair 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0821002004capacity up to and including 300 pounds
K0822001003Power wheelchair, group 2 standard, sling/solid seat/back, patient weight       PWC gp 2 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0822002004capacity up to and including 300 pounds
K0823001003Power wheelchair, group 2 standard, captains chair, patient weight capacity up  PWC gp 2 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0823002004to and including 300 pounds
K0824001003Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight     PWC gp 2 hd seat/back       36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0824002004capacity 301 to 450 pounds
K0825001003Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity   PWC gp 2 hd cap chair       36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0825002004301 to 450 pounds
K0826001003Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient       PWC gp 2 vhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0826002004weight capacity 451 to 600 pounds
K0827001003Power wheelchair, group 2 very heavy duty, captains chair, patient weight       PWC gp vhd cap chair        36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0827002004capacity 451 to 600 pounds
K0828001003Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient      PWC gp 2 xtra hd seat/back  36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0828002004weight capacity 601 pounds or more
K0829001003Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601  PWC gp 2 xtra hd cap chair  36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0829002004pounds or more
K0830001003Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back,       PWC gp2 std seat elevate s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0830002004patient weight capacity up to and including 300 pounds
K0831001003Power wheelchair, group 2 standard, seat elevator, captains chair, patient      PWC gp2 std seat elevate cap36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0831002004weight capacity up to and including 300 pounds
K0835001003Power wheelchair, group 2 standard, single power option, sling/solid seat/back, PWC gp2 std sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0835002004patient weight capacity up to and including 300 pounds
K0836001003Power wheelchair, group 2 standard, single power option, captains chair,        PWC gp2 std sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0836002004patient weight capacity up to and including 300 pounds
K0837001003Power wheelchair, group 2 heavy duty, single power option, sling/solid          PWC gp 2 hd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0837002004seat/back, patient weight capacity 301 to 450 pounds
K0838001003Power wheelchair, group 2 heavy duty, single power option, captains chair,      PWC gp 2 hd sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0838002004patient weight capacity 301 to 450 pounds
K0839001003Power wheelchair, group 2 very heavy duty, single power option sling/solid      PWC gp2 vhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0839002004seat/back, patient weight capacity 451 to 600 pounds
K0840001003Power wheelchair, group 2 extra heavy duty, single power option, sling/solid    PWC gp2 xhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0840002004seat/back, patient weight capacity 601 pounds or more
K0841001003Power wheelchair, group 2 standard, multiple power option, sling/solid          PWC gp2 std mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0841002004seat/back, patient weight capacity up to and including 300 pounds
K0842001003Power wheelchair, group 2 standard, multiple power option, captains chair,      PWC gp2 std mult pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0842002004patient weight capacity up to and including 300 pounds
K0843001003Power wheelchair, group 2 heavy duty, multiple power option, sling/solid        PWC gp2 hd mult pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0843002004seat/back, patient weight capacity 301 to 450 pounds
K0848001003Power wheelchair, group 3 standard, sling/solid seat/back, patient weight       PWC gp 3 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0848002004capacity up to and including 300 pounds
K0849001003Power wheelchair, group 3 standard, captains chair, patient weight capacity up  PWC gp 3 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0849002004to and including 300 pounds
K0850001003Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight     PWC gp 3 hd seat/back       36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0850002004capacity 301 to 450 pounds
K0851001003Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity   PWC gp 3 hd cap chair       36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0851002004301 to 450 pounds
K0852001003Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient       PWC gp 3 vhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0852002004weight capacity 451 to 600 pounds
K0853001003Power wheelchair, group 3 very heavy duty, captains chair, patient weight       PWC gp 3 vhd cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0853002004capacity 451 to 600 pounds
K0854001003Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient      PWC gp 3 xhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0854002004weight capacity 601 pounds or more
K0855001003Power wheelchair, group 3 extra heavy duty, captains chair, patient weight      PWC gp 3 xhd cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0855002004capacity 601 pounds or more
K0856001003Power wheelchair, group 3 standard, single power option, sling/solid seat/back, PWC gp3 std sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0856002004patient weight capacity up to and including 300 pounds
K0857001003Power wheelchair, group 3 standard, single power option, captains chair,        PWC gp3 std sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0857002004patient weight capacity up to and including 300 pounds
K0858001003Power wheelchair, group 3 heavy duty, single power option, sling/solid          PWC gp3 hd sing pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0858002004seat/back, patient weight 301 to 450 pounds
K0859001003Power wheelchair, group 3 heavy duty, single power option, captains chair,      PWC gp3 hd sing pow opt cap 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0859002004patient weight capacity 301 to 450 pounds
K0860001003Power wheelchair, group 3 very heavy duty, single power option, sling/solid     PWC gp3 vhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0860002004seat/back, patient weight capacity 451 to 600 pounds
K0861001003Power wheelchair, group 3 standard, multiple power option, sling/solid          PWC gp3 std mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0861002004seat/back, patient weight capacity up to and including 300 pounds
K0862001003Power wheelchair, group 3 heavy duty, multiple power option, sling/solid        PWC gp3 hd mult pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0862002004seat/back, patient weight capacity 301 to 450 pounds
K0863001003Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid   PWC gp3 vhd mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0863002004seat/back, patient weight capacity 451 to 600 pounds
K0864001003Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid  PWC gp3 xhd mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0864002004seat/back, patient weight capacity 601 pounds or more
K0868001003Power wheelchair, group 4 standard, sling/solid seat/back, patient weight       PWC gp 4 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0868002004capacity up to and including 300 pounds
K0869001003Power wheelchair, group 4 standard, captains chair, patient weight capacity up  PWC gp 4 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0869002004to and including 300 pounds
K0870001003Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight     PWC gp 4 hd seat/back       36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0870002004capacity 301 to 450 pounds
K0871001003Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient       PWC gp 4 vhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0871002004weight capacity 451 to 600 pounds
K0877001003Power wheelchair, group 4 standard, single power option, sling/solid seat/back, PWC gp4 std sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0877002004patient weight capacity up to and including 300 pounds
K0878001003Power wheelchair, group 4 standard, single power option, captains chair,        PWC gp4 std sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0878002004patient weight capacity up to and including 300 pounds
K0879001003Power wheelchair, group 4 heavy duty, single power option, sling/solid          PWC gp4 hd sing pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0879002004seat/back, patient weight capacity 301 to 450 pounds
K0880001003Power wheelchair, group 4 very heavy duty, single power option, sling/solid     PWC gp4 vhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0880002004seat/back, patient weight 451 to 600 pounds
K0884001003Power wheelchair, group 4 standard, multiple power option, sling/solid          PWC gp4 std mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0884002004seat/back, patient weight capacity up to and including 300 pounds
K0885001003Power wheelchair, group 4 standard, multiple power option, captains chair,      PWC gp4 std mult pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0885002004patient weight capacity up to and including 300 pounds
K0886001003Power wheelchair, group 4 heavy duty, multiple power option, sling/solid        PWC gp4 hd mult pow s/b     36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0886002004seat/back, patient weight capacity 301 to 450 pounds
K0890001003Power wheelchair, group 5 pediatric, single power option, sling/solid           PWC gp5 ped sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0890002004seat/back, patient weight capacity up to and including 125 pounds
K0891001003Power wheelchair, group 5 pediatric, multiple power option, sling/solid         PWC gp5 ped mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0891002004seat/back, patient weight capacity up to and including 125 pounds
K0898001003Power wheelchair, not otherwise classified                                      Power wheelchair NOC        36      A                                                                                                     C                          D1D APR    02006100120061001        N
K0899001003Power mobility device, not coded by dme pdac or does not meet criteria          Pow mobil dev no dmepdac    36      A                                                                                                     C                          D1D APR    02006100120100701        N
L0112001003Cranial cervical orthosis, congenital torticollis type, with or without soft    Cranial cervical orthosis   38      A                                                                                                     C                          D1F P      02004010120040101        N
L0112002004interface material, adjustable range of motion joint, custom fabricated
L0113001003Cranial cervical orthosis, torticollis type, with or without joint, with or     Cranial cervical torticollis38      A                                                                                                     C                          D1F P      02009010120090101        N
L0113002004without soft interface material, prefabricated, includes fitting and adjustment
L0120001003Cervical, flexible, non-adjustable (foam collar)                                Cerv flexible non-adjustable38      A                                                                                                     C                          D1F P      01982010119960101        N
L0130001003Cervical, flexible, thermoplastic collar, molded to patient                     Flex thermoplastic collar mo38      A                                                                                                     C                          D1F P      01984010119960101        N
L0140001003Cervical, semi-rigid, adjustable (plastic collar)                               Cervical semi-rigid adjustab38      A                                                                                                     C                          D1F P      01982010119960101        N
L0150001003Cervical, semi-rigid, adjustable molded chin cup (plastic collar with           Cerv semi-rig adj molded chn38      A                                                                                                     C                          D1F P      01982010119960101        N
L0150002004mandibular/occipital piece)
L0160001003Cervical, semi-rigid, wire frame occipital/mandibular support                   Cerv semi-rig wire occ/mand 38      A                                                                                                     C                          D1F P      01982010119960101        N
L0170001003Cervical, collar, molded to patient model                                       Cervical collar molded to pt38      A                                                                                                     C                          D1F P      01986010119960101        N
L0172001003Cervical, collar, semi-rigid thermoplastic foam, two piece                      Cerv col thermplas foam 2 pi38      A                                                                                                     C                          D1F P      01988010119960101        N
L0174001003Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic       Cerv col foam 2 piece w thor38      A                                                                                                     C                          D1F P      01988010119960101        N
L0174002004extension
L0180002003Cervical, multiple post collar, occipital/mandibular supports, adjustable       Cer post col occ/man sup adj38      A                                                                                                     C                          D1F P      01984010119960101        N
L0190001003Cervical, multiple post collar, occipital/mandibular supports, adjustable       Cerv collar supp adj cerv ba38      A                                                                                                     C                          D1F P      01982010119960101        N
L0190002004cervical bars (somi, guilford, taylor types)
L0200001003Cervical, multiple post collar, occipital/mandibular supports, adjustable       Cerv col supp adj bar & thor38      A                                                                                                     C                          D1F P      01984010119960101        N
L0200002004cervical bars, and thoracic extension
L0210002003Thoracic, rib belt                                                              Thoracic rib belt           38      A                                                                                                     C                          D1F P      0198201012010010120091231N
L0220001003Thoracic, rib belt, custom fabricated                                           Thor rib belt custom fabrica38      A                                                                                                     C                          D1F P      01982010119960101        N
L0430001003Spinal orthosis, anterior-posterior-lateral control, with interface material,   Dewall posture protector    38      A                                                                                                     C                          D1F P      01988010120050101        N
L0430002004custom fitted (dewall posture protector only)
L0450001003Tlso, flexible, provides trunk support, upper thoracic region, produces         TLSO flex prefab thoracic   38      A                                                                                                     C                          D1F P      02003010120030101        N
L0450002004intracavitary pressure to reduce load on the intervertebral disks with rigid
L0450003004stays or panel(s), includes shoulder straps and closures, prefabricated,
L0450004004includes fitting and adjustment
L0452001003Tlso, flexible, provides trunk support, upper thoracic region, produces         tlso flex custom fab thoraci38      A                                                                                                     C                          D1F P      02003010120030101        N
L0452002004intracavitary pressure to reduce load on the intervertebral disks with rigid
L0452003004stays or panel(s), includes shoulder straps and closures, custom fabricated
L0454001003Tlso flexible, provides trunk support, extends from sacrococcygeal junction to  TLSO flex prefab sacrococ-T938      A                                                                                                     C                          D1F P      02003010120030101        N
L0454002004above t-9 vertebra, restricts gross trunk motion in the sagittal plane,
L0454003004produces intracavitary pressure to reduce load on the intervertebral disks with
L0454004004rigid stays or panel(s), includes shoulder straps and closures, prefabricated,
L0454005004includes fitting and adjustment
L0456001003Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel  TLSO flex prefab            38      A                                                                                                     C                          D1F P      02003010120030101        N
L0456002004and soft anterior apron, extends from the sacrococcygeal junction and
L0456003004terminates just inferior to the scapular spine, restricts gross trunk motion in
L0456004004the sagittal plane, produces intracavitary pressure to reduce load on the
L0456005004intervertebral disks, includes straps and closures, prefabricated, includes
L0456006004fitting and adjustment
L0458001003Tlso, triplanar control, modular segmented spinal system, two rigid plastic     TLSO 2Mod symphis-xipho pre 38      A                                                                                                     C                          D1F P      02003010120030101        N
L0458002004shells, posterior extends from the sacrococcygeal junction and terminates just
L0458003004inferior to the scapular spine, anterior extends from the symphysis pubis to
L0458004004the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal,
L0458005004and tranverse planes, lateral strength is provided by overlapping plastic and
L0458006004stabilizing closures, includes straps and closures, prefabricated, includes
L0458007004fitting and adjustment
L0460001003Tlso, triplanar control, modular segmented spinal system, two rigid plastic     TLSO2Mod symphysis-stern pre38      A                                                                                                     C                          D1F P      02003010120030101        N
L0460002004shells, posterior extends from the sacrococcygeal junction and terminates just
L0460003004inferior to the scapular spine, anterior extends from the symphysis pubis to
L0460004004the sternal notch, soft liner, restricts gross trunk motion in the sagittal,
L0460005004coronal, and transverse planes, lateral strength is provided by overlapping
L0460006004plastic and stabilizing closures, includes straps and closures, prefabricated,
L0460007004includes fitting and adjustment
L0462001003Tlso, triplanar control, modular segmented spinal system, three rigid plastic   TLSO 3Mod sacro-scap pre    38      A                                                                                                     C                          D1F P      02003010120030101        N
L0462002004shells, posterior extends from the sacrococcygeal junction and terminates just
L0462003004inferior to the scapular spine, anterior extends from the symphysis pubis to
L0462004004the sternal notch, soft liner, restricts gross trunk motion in the sagittal,
L0462005004coronal, and transverse planes, lateral strength is provided by overlapping
L0462006004plastic and stabilizing closures, includes straps and closures, prefabricated,
L0462007004includes fitting and adjustment
L0464001003Tlso, triplanar control, modular segmented spinal system, four rigid plastic    TLSO 4Mod sacro-scap pre    38      A                                                                                                     C                          D1F P      02003010120030101        N
L0464002004shells, posterior extends from sacrococcygeal junction and terminates just
L0464003004inferior to scapular spine, anterior extends from symphysis pubis to the
L0464004004sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal,
L0464005004and transverse planes, lateral strength is provided by overlapping plastic and
L0464006004stabilizing closures, includes straps and closures, prefabricated, includes
L0464007004fitting and adjustment
L0466001003Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron  TLSO rigid frame pre soft ap38      A                                                                                                     C                          D1F P      02003010120030101        N
L0466002004with straps, closures and padding, restricts gross trunk motion in sagittal
L0466003004plane, produces intracavitary pressure to reduce load on intervertebral disks,
L0466004004includes fitting and shaping the frame, prefabricated, includes fitting and
L0466005004adjustment
L0468001003Tlso, sagittal-coronal control, rigid posterior frame and flexible soft         TLSO rigid frame prefab pelv38      A                                                                                                     C                          D1F P      02003010120030101        N
L0468002004anterior apron with straps, closures and padding, extends from sacrococcygeal
L0468003004junction over scapulae, lateral strength provided by pelvic, thoracic, and
L0468004004lateral frame pieces, restricts gross trunk motion in sagittal, and coronal
L0468005004planes, produces intracavitary pressure to reduce load on intervertebral disks,
L0468006004includes fitting and shaping the frame, prefabricated, includes fitting and
L0468007004adjustment
L0470001003Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron TLSO rigid frame pre subclav38      A                                                                                                     C                          D1F P      02003010120030101        N
L0470002004with straps, closures and padding extends from sacrococcygeal junction to
L0470003004scapula, lateral strength provided by pelvic, thoracic, and lateral frame
L0470004004pieces, rotational strength provided by subclavicular extensions, restricts
L0470005004gross trunk motion in sagittal, coronal, and transverse planes, provides
L0470006004intracavitary pressure to reduce load on the intervertebral disks, includes
L0470007004fitting and shaping the frame, prefabricated, includes fitting and adjustment
L0472001003Tlso, triplanar control, hyperextension, rigid anterior and lateral frame       TLSO rigid frame hyperex pre38      A                                                                                                     C                          D1F P      02003010120030101        N
L0472002004extends from symphysis pubis to sternal notch with two anterior components (one
L0472003004pubic and one sternal), posterior and lateral pads with straps and closures,
L0472004004limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and
L0472005004transverse planes, includes fitting and shaping the frame, prefabricated,
L0472006004includes fitting and adjustment
L0480001003Tlso, triplanar control, one piece rigid plastic shell without interface liner, TLSO rigid plastic custom fa38      A                                                                                                     C                          D1F P      02003010120040101        N
L0480002004with multiple straps and closures, posterior extends from sacrococcygeal
L0480003004junction and terminates just inferior to scapular spine, anterior extends from
L0480004004symphysis pubis to sternal notch, anterior or posterior opening, restricts
L0480005004gross trunk motion in sagittal, coronal, and transverse planes, includes a
L0480006004carved plaster or cad-cam model, custom fabricated
L0482001003Tlso, triplanar control, one piece rigid plastic shell with interface liner,    TLSO rigid lined custom fab 38      A                                                                                                     C                          D1F P      02003010120030101        N
L0482002004multiple straps and closures, posterior extends from sacrococcygeal junction
L0482003004and terminates just inferior to scapular spine, anterior extends from symphysis
L0482004004pubis to sternal notch, anterior or posterior opening, restricts gross trunk
L0482005004motion in sagittal, coronal, and transverse planes, includes a carved plaster
L0482006004or cad-cam model, custom fabricated
L0484001003Tlso, triplanar control, two piece rigid plastic shell without interface liner, TLSO rigid plastic cust fab 38      A                                                                                                     C                          D1F P      02003010120030101        N
L0484002004with multiple straps and closures, posterior extends from sacrococcygeal
L0484003004junction and terminates just inferior to scapular spine, anterior extends from
L0484004004symphysis pubis to sternal notch, lateral strength is enhanced by overlapping
L0484005004plastic, restricts gross trunk motion in the sagittal, coronal, and transverse
L0484006004planes, includes a carved plaster or cad-cam model, custom fabricated
L0486001003Tlso, triplanar control, two piece rigid plastic shell with interface liner,    TLSO rigidlined cust fab two38      A                                                                                                     C                          D1F P      02003010120030101        N
L0486002004multiple straps and closures, posterior extends from sacrococcygeal junction
L0486003004and terminates just inferior to scapular spine, anterior extends from symphysis
L0486004004pubis to sternal notch, lateral strength is enhanced by overlapping plastic,
L0486005004restricts gross trunk motion in the sagittal, coronal, and transverse planes,
L0486006004includes a carved plaster or cad-cam model, custom fabricated
L0488001003Tlso, triplanar control, one piece rigid plastic shell with interface liner,    TLSO rigid lined pre one pie38      A                                                                                                     C                          D1F P      02003010120030101        N
L0488002004multiple straps and closures, posterior extends from sacrococcygeal junction
L0488003004and terminates just inferior to scapular spine, anterior extends from symphysis
L0488004004pubis to sternal notch, anterior or posterior opening, restricts gross trunk
L0488005004motion in sagittal, coronal, and transverse planes, prefabricated, includes
L0488006004fitting and adjustment
L0490001003Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping TLSO rigid plastic pre one  38      A                                                                                                     C                          D1F P      02003010120030101        N
L0490002004reinforced anterior, with multiple straps and closures, posterior extends from
L0490003004sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior
L0490004004extends from symphysis pubis to xiphoid, anterior opening, restricts gross
L0490005004trunk motion in sagittal and coronal planes, prefabricated, includes fitting
L0490006004and adjustment
L0491001003Tlso, sagittal-coronal control, modular segmented spinal system, two rigid      TLSO 2 piece rigid shell    38      A                                                                                                     C                          D1F P      02006010120060101        N
L0491002004plastic shells, posterior extends from the sacrococcygeal junction and
L0491003004terminates just inferior to the scapular spine, anterior extends from the
L0491004004symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the
L0491005004sagittal and coronal planes, lateral strength is provided by overlapping
L0491006004plastic and stabilizing closures, includes straps and closures, prefabricated,
L0491007004includes fitting and adjustment
L0492001003Tlso, sagittal-coronal control, modular segmented spinal system, three rigid    TLSO 3 piece rigid shell    38      A                                                                                                     C                          D1F P      02006010120060101        N
L0492002004plastic shells, posterior extends from the sacrococcygeal junction and
L0492003004terminates just inferior to the scapular spine, anterior extends from the
L0492004004symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the
L0492005004sagittal and coronal planes, lateral strength is provided by overlapping
L0492006004plastic and stabilizing closures, includes straps and closures, prefabricated,
L0492007004includes fitting and adjustment
L0621001003Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion   SIO flex pelvisacral prefab 38      A                                                                                                     C                          D1F P      02006010120060101        N
L0621002004about the sacroiliac joint, includes straps, closures, may include pendulous
L0621003004abdomen design, prefabricated, includes fitting and adjustment
L0622001003Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion   SIO flex pelvisacral custom 38      A                                                                                                     C                          D1F P      02006010120060101        N
L0622002004about the sacroiliac joint, includes straps, closures, may include pendulous
L0622003004abdomen design, custom fabricated
L0623001003Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid   SIO panel prefab            38      A                                                                                                     C                          D1F P      02006010120060101        N
L0623002004panels over the sacrum and abdomen, reduces motion about the sacroiliac joint,
L0623003004includes straps, closures, may include pendulous abdomen design, prefabricated,
L0623004004includes fitting and adjustment
L0624001003Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid   SIO panel custom            38      A                                                                                                     C                          D1F P      02006010120060101        N
L0624002004panels placed over the sacrum and abdomen, reduces motion about the sacroiliac
L0624003004joint, includes straps, closures, may include pendulous abdomen design, custom
L0624004004fabricated
L0625001003Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1  LO flexibl L1-below L5 pre  38      A                                                                                                     C                          D1F P      02006010120060101        N
L0625002004to below l-5 vertebra, produces intracavitary pressure to reduce load on the
L0625003004intervertebral discs, includes straps, closures, may include pendulous abdomen
L0625004004design, shoulder straps, stays, prefabricated, includes fitting and adjustment
L0626001003Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior     LO sag stays/panels pre-fab 38      A                                                                                                     C                          D1F P      02006010120060101        N
L0626002004extends from l-1 to below l-5 vertebra, produces intracavitary pressure to
L0626003004reduce load on the intervertebral discs, includes straps, closures, may include
L0626004004padding, stays, shoulder straps, pendulous abdomen design, prefabricated,
L0626005004includes fitting and adjustment
L0627001003Lumbar orthosis, sagittal control, with rigid anterior and posterior panels,    LO sagitt rigid panel prefab38      A                                                                                                     C                          D1F P      02006010120060101        N
L0627002004posterior extends from l-1 to below l-5 vertebra, produces intracavitary
L0627003004pressure to reduce load on the intervertebral discs, includes straps, closures,
L0627004004may include padding, shoulder straps, pendulous abdomen design, prefabricated,
L0627005004includes fitting and adjustment
L0628001003Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior      LO flex w/o rigid stays pre 38      A                                                                                                     C                          D1F P      02006010120060101        N
L0628002004extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary
L0628003004pressure to reduce load on the intervertebral discs, includes straps, closures,
L0628004004may include stays, shoulder straps, pendulous abdomen design, prefabricated,
L0628005004includes fitting and adjustment
L0629001003Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior      LSO flex w/rigid stays cust 38      A                                                                                                     C                          D1F P      02006010120060101        N
L0629002004extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary
L0629003004pressure to reduce load on the intervertebral discs, includes straps, closures,
L0629004004may include stays, shoulder straps, pendulous abdomen design, custom fabricated
L0630001003Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s),        LSO post rigid panel pre    38      A                                                                                                     C                          D1F P      02006010120060101        N
L0630002004posterior extends from sacrococcygeal junction to t-9 vertebra, produces
L0630003004intracavitary pressure to reduce load on the intervertebral discs, includes
L0630004004straps, closures, may include padding, stays, shoulder straps, pendulous
L0630005004abdomen design, prefabricated, includes fitting and adjustment
L0631001003Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior     LSO sag-coro rigid frame pre38      A                                                                                                     C                          D1F P      02006010120070101        N
L0631002004panels, posterior extends from sacrococcygeal junction to t-9 vertebra,
L0631003004produces intracavitary pressure to reduce load on the intervertebral discs,
L0631004004includes straps, closures, may include padding, shoulder straps, pendulous
L0631005004abdomen design, prefabricated, includes fitting and adjustment
L0632001003Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior     LSO sag rigid frame cust    38      A                                                                                                     C                          D1F P      02006010120060101        N
L0632002004panels, posterior extends from sacrococcygeal junction to t-9 vertebra,
L0632003004produces intracavitary pressure to reduce load on the intervertebral discs,
L0632004004includes straps, closures, may include padding, shoulder straps, pendulous
L0632005004abdomen design, custom fabricated
L0633001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior          LSO flexion control prefab  38      A                                                                                                     C                          D1F P      02006010120060101        N
L0633002004frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra,
L0633003004lateral strength provided by rigid lateral frame/panels, produces intracavitary
L0633004004pressure to reduce load on intervertebral discs, includes straps, closures, may
L0633005004include padding, stays, shoulder straps, pendulous abdomen design,
L0633006004prefabricated, includes fitting and adjustment
L0634001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior          LSO flexion control custom  38      A                                                                                                     C                          D1F P      02006010120060101        N
L0634002004frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra,
L0634003004lateral strength provided by rigid lateral frame/panel(s), produces
L0634004004intracavitary pressure to reduce load on intervertebral discs, includes straps,
L0634005004closures, may include padding, stays, shoulder straps, pendulous abdomen
L0634006004design, custom fabricated
L0635001003Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid         LSO sagit rigid panel prefab38      A                                                                                                     C                          D1F P      02006010120060101        N
L0635002004posterior frame/panel(s), lateral articulating design to flex the lumbar spine,
L0635003004posterior extends from sacrococcygeal junction to t-9 vertebra, lateral
L0635004004strength provided by rigid lateral frame/panel(s), produces intracavitary
L0635005004pressure to reduce load on intervertebral discs, includes straps, closures, may
L0635006004include padding, anterior panel, pendulous abdomen design, prefabricated,
L0635007004includes fitting and adjustment
L0636001003Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid         LSO sagittal rigid panel cus38      A                                                                                                     C                          D1F P      02006010120060101        N
L0636002004posterior frame/panels, lateral articulating design to flex the lumbar spine,
L0636003004posterior extends from sacrococcygeal junction to t-9 vertebra, lateral
L0636004004strength provided by rigid lateral frame/panels, produces intracavitary
L0636005004pressure to reduce load on intervertebral discs, includes straps, closures, may
L0636006004include padding, anterior panel, pendulous abdomen design, custom fabricated
L0637001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and       LSO sag-coronal panel prefab38      A                                                                                                     C                          D1F P      02006010120060101        N
L0637002004posterior frame/panels, posterior extends from sacrococcygeal junction to t-9
L0637003004vertebra, lateral strength provided by rigid lateral frame/panels, produces
L0637004004intracavitary pressure to reduce load on intervertebral discs, includes straps,
L0637005004closures, may include padding, shoulder straps, pendulous abdomen design,
L0637006004prefabricated, includes fitting and adjustment
L0638001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and       LSO sag-coronal panel custom38      A                                                                                                     C                          D1F P      02006010120060101        N
L0638002004posterior frame/panels, posterior extends from sacrococcygeal junction to t-9
L0638003004vertebra, lateral strength provided by rigid lateral frame/panels, produces
L0638004004intracavitary pressure to reduce load on intervertebral discs, includes straps,
L0638005004closures, may include padding, shoulder straps, pendulous abdomen design,
L0638006004custom fabricated
L0639001003Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s),      LSO s/c shell/panel prefab  38      A                                                                                                     C                          D1F P      02006010120060101        N
L0639002004posterior extends from sacrococcygeal junction to t-9 vertebra, anterior
L0639003004extends from symphysis pubis to xyphoid, produces intracavitary pressure to
L0639004004reduce load on the intervertebral discs, overall strength is provided by
L0639005004overlapping rigid material and stabilizing closures, includes straps, closures,
L0639006004may include soft interface, pendulous abdomen design, prefabricated, includes
L0639007004fitting and adjustment
L0640001003Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s),      LSO s/c shell/panel custom  38      A                                                                                                     C                          D1F P      02006010120060101        N
L0640002004posterior extends from sacrococcygeal junction to t-9 vertebra, anterior
L0640003004extends from symphysis pubis to xyphoid, produces intracavitary pressure to
L0640004004reduce load on the intervertebral discs, overall strength is provided by
L0640005004overlapping rigid material and stabilizing closures, includes straps, closures,
L0640006004may include soft interface, pendulous abdomen design, custom fabricated
L0700004003Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral    Ctlso a-p-l control molded  38      A                                                                                                     C                          D1F P      01984010119960101        N
L0700005004control, molded to patient model, (minerva type)
L0710001003Ctlso, anterior-posterior-lateral-control, molded to patient model, with        Ctlso a-p-l control w/ inter38      A                                                                                                     C                          D1F P      01984010119960101        N
L0710002004interface material, (minerva type)
L0810002003Halo procedure,  cervical halo incorporated into jacket vest                    Halo cervical into jckt vest38      A                                                                                                     C                          D1F P      01986010119960101        N
L0820001003Halo procedure,  cervical halo incorporated into plaster body jacket            Halo cervical into body jack38      A                                                                                                     C                          D1F P      01986010119960101        N
L0830001003Halo procedure,  cervical halo incorporated into milwaukee type orthosis        Halo cerv into milwaukee typ38      A                                                                                                     C                          D1F P      01986010119960101        N
L0859001003Addition to halo procedure, magnetic resonance image compatible systems, rings  MRI compatible system       38      A                                                                                                     C                          D1F P      02006010120060101        N
L0859002004and pins, any material
L0861001003Addition to halo procedure, replacement liner/interface material                Halo repl liner/interface   38      A                                                                                                     C                          D1F P      02004010120040101        N
L0970002003Tlso, corset front                                                              Tlso corset front           38      A                                                                                                     C                          D1F P      01982010119960101        N
L0972001003Lso, corset front                                                               Lso corset front            38      A                                                                                                     C                          D1F P      01982010119960101        N
L0974001003Tlso, full corset                                                               Tlso full corset            38      A                                                                                                     C                          D1F P      01982010119960101        N
L0976001003Lso, full corset                                                                Lso full corset             38      A                                                                                                     C                          D1F P      01982010119960101        N
L0978001003Axillary crutch extension                                                       Axillary crutch extension   38      A                                                                                                     C                          D1F P      01982010119960101        N
L0980001003Peroneal straps, pair                                                           Peroneal straps pair        38      A                                                                                                     C                          D1F P      01986010119960101        N
L0982001003Stocking supporter grips, set of four (4)                                       Stocking supp grips set of f38      A                                                                                                     C                          D1F P      01982010119960101        N
L0984001003Protective body sock, each                                                      Protective body sock each   38      A                                                                                                     C                          D1F P      01994010119960101        N
L0999001003Addition to spinal orthosis, not otherwise specified                            Add to spinal orthosis NOS  46      A                                                                                                     C                          D1F P      01998010119980101        N
L1000018003Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of      Ctlso milwauke initial model38      A                                                                                                     C                          D1F P      01986010119960101        N
L1000019004furnishing initial orthosis, including model
L1001001003Cervical thoracic lumbar sacral orthosis, immobilizer, infant size,             CTLSO infant immobilizer    38      A                                                                                                     C                          D1F P      02007010120070101        N
L1001002004prefabricated, includes fitting and adjustment
L1005001003Tension based scoliosis orthosis and accessory pads, includes fitting and       Tension based scoliosis orth38      A                                                                                                     C                          D1F P      02002010120020101        N
L1005002004adjustment
L1010002003Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis       Ctlso axilla sling          38      A                                                                                                     C                          D1F P      01986010119960101        N
L1010003004orthosis, axilla sling
L1020001003Addition to ctlso or scoliosis orthosis, kyphosis pad                           Kyphosis pad                38      A                                                                                                     C                          D1F P      01986010119960101        N
L1025001003Addition to ctlso or scoliosis orthosis, kyphosis pad, floating                 Kyphosis pad floating       38      A                                                                                                     C                          D1F P      01988010119960101        N
L1030001003Addition to ctlso or scoliosis orthosis, lumbar bolster pad                     Lumbar bolster pad          38      A                                                                                                     C                          D1F P      01986010119960101        N
L1040001003Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad               Lumbar or lumbar rib pad    38      A                                                                                                     C                          D1F P      01986010119960101        N
L1050001003Addition to ctlso or scoliosis orthosis, sternal pad                            Sternal pad                 38      A                                                                                                     C                          D1F P      01986010119960101        N
L1060001003Addition to ctlso or scoliosis orthosis, thoracic pad                           Thoracic pad                38      A                                                                                                     C                          D1F P      01986010119960101        N
L1070001003Addition to ctlso or scoliosis orthosis, trapezius sling                        Trapezius sling             38      A                                                                                                     C                          D1F P      01986010119960101        N
L1080001003Addition  to ctlso or scoliosis orthosis, outrigger                             Outrigger                   38      A                                                                                                     C                          D1F P      01986010119960101        N
L1085001003Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical     Outrigger bil w/ vert extens38      A                                                                                                     C                          D1F P      01988010119960101        N
L1085002004extensions
L1090001003Addition to ctlso or scoliosis orthosis, lumbar sling                           Lumbar sling                38      A                                                                                                     C                          D1F P      01986010119960101        N
L1100001003Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather        Ring flange plastic/leather 38      A                                                                                                     C                          D1F P      01986010119960101        N
L1110001003Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather,       Ring flange plas/leather mol38      A                                                                                                     C                          D1F P      01986010119960101        N
L1110002004molded to patient model
L1120001003Addition to ctlso, scoliosis orthosis, cover for upright, each                  Covers for upright each     38      A                                                                                                     C                          D1F P      01986010119960101        N
L1200002003Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial         Furnsh initial orthosis only38      A                                                                                                     C                          D1F P      01986010119960101        N
L1200003004orthosis only
L1210001003Addition to tlso, (low profile), lateral thoracic extension                     Lateral thoracic extension  38      A                                                                                                     C                          D1F P      01986010119960101        N
L1220001003Addition to tlso, (low profile), anterior thoracic extension                    Anterior thoracic extension 38      A                                                                                                     C                          D1F P      01986010119960101        N
L1230001003Addition to tlso, (low profile), milwaukee type superstructure                  Milwaukee type superstructur38      A                                                                                                     C                          D1F P      01986010119960101        N
L1240001003Addition to tlso, (low profile), lumbar derotation pad                          Lumbar derotation pad       38      A                                                                                                     C                          D1F P      01988010119960101        N
L1250001003Addition to tlso, (low profile), anterior asis pad                              Anterior asis pad           38      A                                                                                                     C                          D1F P      01988010119960101        N
L1260001003Addition to tlso, (low profile), anterior thoracic derotation pad               Anterior thoracic derotation38      A                                                                                                     C                          D1F P      01988010119960101        N
L1270001003Addition to tlso, (low profile), abdominal pad                                  Abdominal pad               38      A                                                                                                     C                          D1F P      01988010119960101        N
L1280001003Addition to tlso, (low profile), rib gusset (elastic), each                     Rib gusset (elastic) each   38      A                                                                                                     C                          D1F P      01988010119960101        N
L1290001003Addition to tlso, (low profile), lateral trochanteric pad                       Lateral trochanteric pad    38      A                                                                                                     C                          D1F P      01988010119960101        N
L1300002003Other scoliosis procedure, body jacket molded to patient model                  Body jacket mold to patient 38      A                                                                                                     C                          D1F P      01986010119960101        N
L1310001003Other scoliosis procedure,  post-operative body jacket                          Post-operative body jacket  38      A                                                                                                     C                          D1F P      01986010119960101        N
L1499001003Spinal orthosis, not otherwise specified                                        Spinal orthosis NOS         46      A                                                                                                     C                          D1F P      01982010119980101        N
L1500002003Thoracic-hip-knee-ankle orthosis (thkao), mobility frame (newington, parapodium Thkao mobility frame        38      A                                                                                                     C                          D1F P      0198601012012010120111231N
L1500003004types)
L1510001003Thkao, standing frame, with or without tray and accessories                     Thkao standing frame        38      A                                                                                                     C                          D1F P      0198201012012010120111231N
L1520001003Thkao, swivel walker                                                            Thkao swivel walker         38      A                                                                                                     C                          D1F P      0198201012012010120111231N
L1600010003Hip orthosis, abduction control of hip joints, flexible, frejka type with       Abduct hip flex frejka w cvr38      A                                                                                                     C                          D1F P      01986010120010101        N
L1600011004cover, prefabricated, includes fitting and adjustment
L1610001003Hip orthosis, abduction control of hip joints, flexible, (frejka cover only),   Abduct hip flex frejka covr 38      A                                                                                                     C                          D1F P      01982010120010101        N
L1610002004prefabricated, includes fitting and adjustment
L1620001003Hip orthosis, abduction control of hip joints, flexible, (pavlik harness),      Abduct hip flex pavlik harne38      A                                                                                                     C                          D1F P      01982010120010101        N
L1620002004prefabricated, includes fitting and adjustment
L1630001003Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type),  Abduct control hip semi-flex38      A                                                                                                     C                          D1F P      01982010120010101        N
L1630002004custom-fabricated
L1640001003Hip orthosis, abduction control of hip joints, static, pelvic band or spreader  Pelv band/spread bar thigh c38      A                                                                                                     C                          D1F P      01982010120010101        N
L1640002004bar, thigh cuffs, custom-fabricated
L1650001003Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled      HO abduction hip adjustable 38      A                                                                                                     C                          D1F P      01982010120010101        N
L1650002004type), prefabricated, includes fitting and adjustment
L1652001003Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar,      HO bi thighcuffs w sprdr bar38      A                                                                                                     C                          D1F P      02003010120030101        N
L1652002004adult size, prefabricated, includes fitting and adjustment, any type
L1660001003Hip orthosis, abduction control of hip joints, static, plastic, prefabricated,  HO abduction static plastic 38      A                                                                                                     C                          D1F P      01982010120010101        N
L1660002004includes fitting and adjustment
L1680001003Hip orthosis, abduction control of hip joints, dynamic, pelvic control,         Pelvic & hip control thigh c38      A                                                                                                     C                          D1F P      01982010120010101        N
L1680002004adjustable hip motion control, thigh cuffs (rancho hip action type), custom
L1680003004fabricated
L1685001003Hip orthosis, abduction control of hip joint, postoperative hip abduction type, Post-op hip abduct custom fa38      A                                                                                                     C                          D1F P      01988010120010101        N
L1685002004custom fabricated
L1686001003Hip orthosis, abduction control of hip joint, postoperative hip abduction type, HO post-op hip abduction    38      A                                                                                                     C                          D1F P      01989010120010101        N
L1686002004prefabricated, includes fitting and adjustment
L1690001003Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction   Combination bilateral HO    38      A                                                                                                     C                          D1F P      01999010120010101        N
L1690002004and internal rotation control, prefabricated, includes fitting and adjustment
L1700002003Legg perthes orthosis, (toronto type), custom-fabricated                        Leg perthes orth toronto typ38      A                                                                                                     C                          D1F P      01982010120010101        N
L1710001003Legg perthes orthosis, (newington type), custom fabricated                      Legg perthes orth newington 38      A                                                                                                     C                          D1F P      01982010120010101        N
L1720001003Legg perthes orthosis, trilateral, (tachdijan type), custom-fabricated          Legg perthes orthosis trilat38      A                                                                                                     C                          D1F P      01985010120010101        N
L1730001003Legg perthes orthosis, (scottish rite type), custom-fabricated                  Legg perthes orth scottish r38      A                                                                                                     C                          D1F P      01982010120010101        N
L1755001003Legg perthes orthosis, (patten bottom type), custom-fabricated                  Legg perthes patten bottom t38      A                                                                                                     C                          D1F P      01988010120010101        N
L1800002003Knee orthosis, elastic with stays, prefabricated, includes fitting and          Knee orthoses elas w stays  38      A                                                                                                     C                          D1F P      0198601012010010120091231N
L1800003004adjustment
L1810001003Knee orthosis, elastic with joints, prefabricated, includes fitting and         Ko elastic with joints      38      A                                                                                                     C                          D1F P      01982010120010101        N
L1810002004adjustment
L1815001003Knee orthosis, elastic or other elastic type material with condylar pad(s),     Elastic with condylar pads  38      A                                                                                                     C                          D1F P      0198801012010010120091231N
L1815002004prefabricated, includes fitting and adjustment
L1820001003Knee orthosis, elastic with condylar pads and joints, with or without patellar  Ko elas w/ condyle pads & jo38      A                                                                                                     C                          D1F P      01986010120050101        N
L1820002004control, prefabricated, includes fitting and adjustment
L1825001003Knee orthosis, elastic knee cap, prefabricated, includes fitting and adjustment Ko elastic knee cap         38      A                                                                                                     C                          D1F P      0198501012010010120091231N
L1830001003Knee orthosis, immobilizer, canvas longitudinal, prefabricated, includes        Ko immobilizer canvas longit38      A                                                                                                     C                          D1F P      01986010120010101        N
L1830002004fitting and adjustment
L1831001003Knee orthosis, locking knee joint(s), positional orthosis, prefabricated,       Knee orth pos locking joint 38      A                                                                                                     C                          D1F P      02004010120040101        N
L1831002004includes fitting and adjustment
L1832001003Knee orthosis, adjustable knee joints (unicentric or polycentric), positional   KO adj jnt pos rigid support38      A                                                                                                     C                          D1F P      01989010120060101        N
L1832002004orthosis, rigid support, prefabricated, includes fitting and adjustment
L1834001003Knee orthosis, without knee joint, rigid, custom-fabricated                     Ko w/0 joint rigid molded to38      A                                                                                                     C                          D1F P      01989010120010101        N
L1836001003Knee orthosis, rigid, without joint(s), includes soft interface material,       Rigid KO wo joints          38      A                                                                                                     C                          D1F P      02003010120030101        N
L1836002004prefabricated, includes fitting and adjustment
L1840001003Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom   Ko derot ant cruciate custom38      A                                                                                                     C                          D1F P      01986010120010101        N
L1840002004fabricated
L1843001003Knee orthosis, single upright, thigh and calf, with adjustable flexion and      KO single upright custom fit38      A                                                                                                     C                          D1F P      01998010120060101        N
L1843002004extension joint (unicentric or polycentric), medial-lateral and rotation
L1843003004control, with or without varus/valgus adjustment,  prefabricated, includes
L1843004004fitting and adjustment
L1844001003Knee orthosis, single upright, thigh and calf, with adjustable flexion and      Ko w/adj jt rot cntrl molded38      A                                                                                                     C                          D1F P      01993010120060101        N
L1844002004extension joint (unicentric or polycentric), medial-lateral and rotation
L1844003004control, with or without  varus/valgus adjustment, custom fabricated
L1845001003Knee orthosis, double upright, thigh and calf, with adjustable flexion and      Ko w/ adj flex/ext rotat cus38      A                                                                                                     C                          D1F P      01988010120060101        N
L1845002004extension joint (unicentric or polycentric), medial-lateral and rotation
L1845003004control, with or without varus/valgus adjustment, prefabricated, includes
L1845004004fitting and adjustment
L1846001003Knee orthosis, double upright, thigh and calf, with adjustable flexion and      Ko w adj flex/ext rotat mold38      A                                                                                                     C                          D1F P      01988010120060101        N
L1846002004extension joint (unicentric or polycentric), medial-lateral and rotation
L1846003004control, with or without varus/valgus adjustment, custom fabricated
L1847001003Knee orthosis, double upright with adjustable joint, with inflatable air        KO adjustable w air chambers38      A                                                                                                     C                          D1F P      01999010120010101        N
L1847002004support chamber(s), prefabricated, includes fitting and adjustment
L1850001003Knee orthosis, swedish type, prefabricated, includes fitting and adjustment     Ko swedish type             38      A                                                                                                     C                          D1F P      01982010120010101        N
L1860001003Knee orthosis, modification of supracondylar prosthetic socket,                 Ko supracondylar socket mold38      A                                                                                                     C                          D1F P      01982010120010101        N
L1860002004custom-fabricated (sk)
L1900002003Ankle foot orthosis, spring wire, dorsiflexion assist calf band,                Afo sprng wir drsflx calf bd38      A                                                                                                     C                          D1F P      01986010120010101        N
L1900003004custom-fabricated
L1901001003Ankle orthosis, elastic, prefabricated, includes fitting and adjustment (e. G.  Prefab ankle orthosis       38      A                                                                                                     C                          D1F P      0200301012010010120091231N
L1901002004Neoprene, lycra)
L1902001003Ankle foot orthosis, ankle gauntlet, prefabricated, includes fitting and        Afo ankle gauntlet          38      A                                                                                                     C                          D1F P      01988010120010101        N
L1902002004adjustment
L1904001003Ankle foot orthosis, molded ankle gauntlet, custom-fabricated                   Afo molded ankle gauntlet   38      A                                                                                                     C                          D1F P      01988010120010101        N
L1906001003Ankle foot orthosis, multiligamentus ankle support, prefabricated, includes     Afo multiligamentus ankle su38      A                                                                                                     C                          D1F P      01988010120010101        N
L1906002004fitting and adjustment
L1907001003Afo, supramalleolar with straps, with or without interface/pads, custom         AFO supramalleolar custom   38      A                                                                                                     C                          D1F P      02004010120040101        N
L1907002004fabricated
L1910001003Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter,   Afo sing bar clasp attach sh38      A                                                                                                     C                          D1F P      01982010120010101        N
L1910002004prefabricated, includes fitting and adjustment
L1920001003Ankle foot orthosis, single upright with static or adjustable stop (phelps or   Afo sing upright w/ adjust s38      A                                                                                                     C                          D1F P      01982010120010101        N
L1920002004perlstein type), custom-fabricated
L1930001003Ankle foot orthosis, plastic or other material, prefabricated, includes fitting Afo plastic                 38      A                                                                                                     C                          D1F P      01982010120020101        N
L1930002004and adjustment
L1932001003Afo, rigid anterior tibial section, total carbon fiber or equal material,       Afo rig ant tib prefab TCF/=38      A                                                                                                     C                          D1F P      02005010120050101        N
L1932002004prefabricated, includes fitting and adjustment
L1940001003Ankle foot orthosis, plastic or other material, custom-fabricated               Afo molded to patient plasti38      A                                                                                                     C                          D1F P      01982010120020101        N
L1945001003Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction),   Afo molded plas rig ant tib 38      A                                                                                                     C                          D1F P      01989010120010101        N
L1945002004custom-fabricated
L1950001003Ankle foot orthosis, spiral, (institute of rehabilitative medicine type),       Afo spiral molded to pt plas38      A                                                                                                     C                          D1F P      01982010120040101        N
L1950002004plastic, custom-fabricated
L1951001003Ankle foot orthosis, spiral, (institute of rehabilitative medicine type),       AFO spiral prefabricated    38      A                                                                                                     C                          D1F P      02004010120040101        N
L1951002004plastic or other material, prefabricated, includes fitting and adjustment
L1960001003Ankle foot orthosis, posterior solid ankle, plastic, custom-fabricated          Afo pos solid ank plastic mo38      A                                                                                                     C                          D1F P      01982010120010101        N
L1970001003Ankle foot orthosis, plastic with ankle joint, custom-fabricated                Afo plastic molded w/ankle j38      A                                                                                                     C                          D1F P      01982010120010101        N
L1971001003Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, AFO w/ankle joint, prefab   38      A                                                                                                     C                          D1F P      02004010120040101        N
L1971002004includes fitting and adjustment
L1980001003Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup,   Afo sing solid stirrup calf 38      A                                                                                                     C                          D1F P      01982010120010101        N
L1980002004calf band/cuff (single bar 'bk' orthosis), custom-fabricated
L1990001003Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup,   Afo doub solid stirrup calf 38      A                                                                                                     C                          D1F P      01982010120010101        N
L1990002004calf band/cuff (double bar 'bk' orthosis), custom-fabricated
L2000004003Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, Kafo sing fre stirr thi/calf38      A                                                                                                     C                          D1F P      01985010120010101        N
L2000005004thigh and calf bands/cuffs (single bar 'ak' orthosis), custom-fabricated
L2005001003Knee ankle foot orthosis, any material, single or double upright, stance        KAFO sng/dbl mechanical act 38      A                                                                                                     C                          D1F P      02005010120120101        N
L2005002004control, automatic lock and swing phase release, any type activation, includes
L2005003004ankle joint, any type, custom fabricated
L2010001003Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and  Kafo sng solid stirrup w/o j38      A                                                                                                     C                          D1F P      01986010120010101        N
L2010002004calf bands/cuffs (single bar 'ak' orthosis), without knee joint,
L2010003004custom-fabricated
L2020001003Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and  Kafo dbl solid stirrup band/38      A                                                                                                     C                          D1F P      01985010120010101        N
L2020002004calf bands/cuffs (double bar 'ak' orthosis), custom-fabricated
L2030001003Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and  Kafo dbl solid stirrup w/o j38      A                                                                                                     C                          D1F P      01986010120010101        N
L2030002004calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom
L2030003004fabricated
L2034001003Knee ankle foot orthosis, full plastic, single upright, with or without free    KAFO pla sin up w/wo k/a cus38      A                                                                                                     C                          D1F P      02006010120060101        N
L2034002004motion knee, medial lateral rotation control, with or without free motion
L2034003004ankle, custom fabricated
L2035001003Knee ankle foot orthosis, full plastic, static (pediatric size), without free   KAFO plastic pediatric size 38      A                                                                                                     C                          D1F P      01998010120050101        N
L2035002004motion ankle, prefabricated, includes fitting and adjustment
L2036001003Knee ankle foot orthosis, full plastic, double upright, with or without free    Kafo plas doub free knee mol38      A                                                                                                     C                          D1F P      01988010120060101        N
L2036002004motion knee, with or without free motion ankle, custom fabricated
L2037001003Knee ankle foot orthosis, full plastic, single upright, with or without free    Kafo plas sing free knee mol38      A                                                                                                     C                          D1F P      01989010120060101        N
L2037002004motion knee, with or without free motion ankle, custom fabricated
L2038001003Knee ankle foot orthosis, full plastic, with or without free motion knee,       Kafo w/o joint multi-axis an38      A                                                                                                     C                          D1F P      01989010120060101        N
L2038002004multi-axis ankle,  custom fabricated
L2040002003Hip knee ankle foot orthosis, torsion control, bilateral rotation straps,       Hkafo torsion bil rot straps38      A                                                                                                     C                          D1F P      01986010120010101        N
L2040003004pelvic band/belt, custom fabricated
L2050001003Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip    Hkafo torsion cable hip pelv38      A                                                                                                     C                          D1F P      01982010120010101        N
L2050002004joint, pelvic band/belt, custom-fabricated
L2060001003Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball   Hkafo torsion ball bearing j38      A                                                                                                     C                          D1F P      01982010120010101        N
L2060002004bearing hip joint, pelvic band/ belt, custom-fabricated
L2070001003Hip knee ankle foot orthosis, torsion control, unilateral rotation straps,      Hkafo torsion unilat rot str38      A                                                                                                     C                          D1F P      01982010120010101        N
L2070002004pelvic band/belt, custom fabricated
L2080001003Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip    Hkafo unilat torsion cable  38      A                                                                                                     C                          D1F P      01986010120010101        N
L2080002004joint, pelvic band/belt, custom-fabricated
L2090001003Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball   Hkafo unilat torsion ball br38      A                                                                                                     C                          D1F P      01984010120010101        N
L2090002004bearing hip joint, pelvic band/ belt, custom-fabricated
L2106001003Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis,          Afo tib fx cast plaster mold38      A                                                                                                     C                          D1F P      01988010120010101        N
L2106002004thermoplastic type casting material, custom-fabricated
L2108001003Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis,          Afo tib fx cast molded to pt38      A                                                                                                     C                          D1F P      01988010120010101        N
L2108002004custom-fabricated
L2112001003Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft,         Afo tibial fracture soft    38      A                                                                                                     C                          D1F P      01988010120010101        N
L2112002004prefabricated, includes fitting and adjustment
L2114001003Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid,   Afo tib fx semi-rigid       38      A                                                                                                     C                          D1F P      01988010120010101        N
L2114002004prefabricated, includes fitting and adjustment
L2116001003Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid,        Afo tibial fracture rigid   38      A                                                                                                     C                          D1F P      01988010120010101        N
L2116002004prefabricated, includes fitting and adjustment
L2126001003Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis,    Kafo fem fx cast thermoplas 38      A                                                                                                     C                          D1F P      01988010120010101        N
L2126002004thermoplastic type casting material, custom-fabricated
L2128001003Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis,    Kafo fem fx cast molded to p38      A                                                                                                     C                          D1F P      01988010120010101        N
L2128002004custom-fabricated
L2132001003Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated,   Kafo femoral fx cast soft   38      A                                                                                                     C                          D1F P      01988010120010101        N
L2132002004includes fitting and adjustment
L2134001003Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid,            Kafo fem fx cast semi-rigid 38      A                                                                                                     C                          D1F P      01988010120010101        N
L2134002004prefabricated, includes fitting and adjustment
L2136001003Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated,  Kafo femoral fx cast rigid  38      A                                                                                                     C                          D1F P      01988010120010101        N
L2136002004includes fitting and adjustment
L2180002003Addition to lower extremity fracture orthosis, plastic shoe insert with ankle   Plas shoe insert w ank joint38      A                                                                                                     C                          D1F P      01988010119960101        N
L2180003004joints
L2182001003Addition to lower extremity fracture orthosis, drop lock knee joint             Drop lock knee              38      A                                                                                                     C                          D1F P      01988010119960101        N
L2184001003Addition to lower extremity fracture orthosis, limited motion knee joint        Limited motion knee joint   38      A                                                                                                     C                          D1F P      01988010119960101        N
L2186001003Addition to lower extremity fracture orthosis, adjustable motion knee joint,    Adj motion knee jnt lerman t38      A                                                                                                     C                          D1F P      01988010119960101        N
L2186002004lerman type
L2188001003Addition to lower extremity fracture orthosis, quadrilateral brim               Quadrilateral brim          38      A                                                                                                     C                          D1F P      01988010119960101        N
L2190001003Addition to lower extremity fracture orthosis, waist belt                       Waist belt                  38      A                                                                                                     C                          D1F P      01988010119960101        N
L2192001003Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh    Pelvic band & belt thigh fla38      A                                                                                                     C                          D1F P      01988010119960101        N
L2192002004flange, and pelvic belt
L2200003003Addition to lower extremity, limited ankle motion, each joint                   Limited ankle motion ea jnt 38      A                                                                                                     C                          D1F P      01986010119960101        N
L2210001003Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each Dorsiflexion assist each joi38      A                                                                                                     C                          D1F P      01986010119960101        N
L2210002004joint
L2220001003Addition to lower extremity, dorsiflexion and plantar flexion assist/resist,    Dorsi & plantar flex ass/res38      A                                                                                                     C                          D1F P      01986010119960101        N
L2220002004each joint
L2230001003Addition to lower extremity, split flat caliper stirrups and plate attachment   Split flat caliper stirr & p38      A                                                                                                     C                          D1F P      01986010119960101        N
L2232001003Addition to lower extremity orthosis, rocker bottom for total contact ankle     Rocker bottom, contact AFO  38      A                                                                                                     C                          D1F P      02005010120050101        N
L2232002004foot orthosis, for custom fabricated orthosis only
L2240001003Addition to lower extremity, round caliper and plate attachment                 Round caliper and plate atta38      A                                                                                                     C                          D1F P      01986010119960101        N
L2250001003Addition  to lower extremity, foot plate, molded to patient model, stirrup      Foot plate molded stirrup at38      A                                                                                                     C                          D1F P      01986010119960101        N
L2250002004attachment
L2260001003Addition  to lower extremity, reinforced solid stirrup (scott-craig type)       Reinforced solid stirrup    38      A                                                                                                     C                          D1F P      01986010119960101        N
L2265001003Addition to lower extremity, long tongue stirrup                                Long tongue stirrup         38      A                                                                                                     C                          D1F P      01989010119960101        N
L2270001003Addition  to lower extremity, varus/valgus correction ('t') strap, padded/lined Varus/valgus strap padded/li38      A                                                                                                     C                          D1F P      01986010119960101        N
L2270002004or malleolus pad
L2275001003Addition to lower extremity, varus/valgus correction, plastic modification,     Plastic mod low ext pad/line38      A                                                                                                     C                          D1F P      01994010119960101        N
L2275002004padded/lined
L2280001003Addition  to lower extremity, molded inner boot                                 Molded inner boot           38      A                                                                                                     C                          D1F P      01986010119960101        N
L2300001003Addition  to lower extremity, abduction bar (bilateral hip involvement),        Abduction bar jointed adjust38      A                                                                                                     C                          D1F P      01986010119960101        N
L2300002004jointed, adjustable
L2310001003Addition  to lower extremity, abduction bar-straight                            Abduction bar-straight      38      A                                                                                                     C                          D1F P      01986010119960101        N
L2320001003Addition to lower extremity, non-molded lacer, for custom fabricated orthosis   Non-molded lacer            38      A                                                                                                     C                          D1F P      01986010120050101        N
L2320002004only
L2330001003Addition to lower extremity, lacer molded to patient model, for custom          Lacer molded to patient mode38      A                                                                                                     C                          D1F P      01986010120050101        N
L2330002004fabricated orthosis only
L2335001003Addition  to lower extremity, anterior swing band                               Anterior swing band         38      A                                                                                                     C                          D1F P      01988010119960101        N
L2340001003Addition  to lower extremity, pre-tibial shell, molded to patient model         Pre-tibial shell molded to p38      A                                                                                                     C                          D1F P      01986010119960101        N
L2350001003Addition  to lower extremity, prosthetic type, (bk) socket, molded to patient   Prosthetic type socket molde38      A                                                                                                     C                          D1F P      01986010119960101        N
L2350002004model, (used for 'ptb' 'afo' orthoses)
L2360001003Addition  to lower extremity, extended steel shank                              Extended steel shank        38      A                                                                                                     C                          D1F P      01986010119960101        N
L2370001003Addition to lower extremity, patten bottom                                      Patten bottom               38      A                                                                                                     C                          D1F P      01988010119960101        N
L2375001003Addition  to lower extremity, torsion control, ankle joint and half solid       Torsion ank & half solid sti38      A                                                                                                     C                          D1F P      01988010119960101        N
L2375002004stirrup
L2380001003Addition  to lower extremity, torsion control, straight knee joint, each joint  Torsion straight knee joint 38      A                                                                                                     C                          D1F P      01988010119960101        N
L2385001003Addition  to lower extremity, straight knee joint, heavy duty, each joint       Straight knee joint heavy du38      A                                                                                                     C                          D1F P      01988010119960101        N
L2387001003Addition to lower extremity, polycentric knee joint, for custom fabricated knee Add LE poly knee custom KAFO38      A                                                                                                     C                          D1F P      02006010120060101        N
L2387002004ankle foot orthosis, each joint
L2390001003Addition  to lower extremity, offset knee joint, each joint                     Offset knee joint each      38      A                                                                                                     C                          D1F P      01988010119960101        N
L2395001003Addition  to lower extremity, offset knee joint, heavy duty, each joint         Offset knee joint heavy duty38      A                                                                                                     C                          D1F P      01988010119960101        N
L2397001003Addition to lower extremity orthosis, suspension sleeve                         Suspension sleeve lower ext 38      A                                                                                                     C                          D1F P      01994010119960101        N
L2405002003Addition to knee joint, drop lock, each                                         Knee joint drop lock ea jnt 38      A                                                                                                     C                          D1F P      01988010120060101        N
L2415001003Addition to knee lock with integrated release mechanism ( bail, cable, or       Knee joint cam lock each joi38      A                                                                                                     C                          D1F P      01988010120020101        N
L2415002004equal), any material, each joint
L2425001003Addition to knee joint, disc or dial lock for adjustable knee flexion, each     Knee disc/dial lock/adj flex38      A                                                                                                     C                          D1F P      01988010119960101        N
L2425002004joint
L2430001003Addition to knee joint, ratchet lock for active and progressive knee extension, Knee jnt ratchet lock ea jnt38      A                                                                                                     C                          D1F P      01997010119970101        N
L2430002004each joint
L2492001003Addition to knee joint, lift loop for drop lock ring                            Knee lift loop drop lock rin38      A                                                                                                     C                          D1F P      01988010119960101        N
L2500003003Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight      Thi/glut/ischia wgt bearing 38      A                                                                                                     C                          D1F P      01986010119960101        N
L2500004004bearing, ring
L2510001003Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded Th/wght bear quad-lat brim m38      A                                                                                                     C                          D1F P      01986010119960101        N
L2510002004to patient model
L2520001003Addition  to lower extremity, thigh/weight bearing, quadri- lateral brim,       Th/wght bear quad-lat brim c38      A                                                                                                     C                          D1F P      01986010119960101        N
L2520002004custom fitted
L2525001003Addition to lower extremity, thigh/weight bearing, ischial containment/narrow   Th/wght bear nar m-l brim mo38      A                                                                                                     C                          D1F P      01989010119960101        N
L2525002004m-l brim molded to patient model
L2526001003Addition to lower extremity, thigh/weight bearing, ischial containment/narrow   Th/wght bear nar m-l brim cu38      A                                                                                                     C                          D1F P      01989010119960101        N
L2526002004m-l brim, custom fitted
L2530001003Addition  to lower extremity, thigh-weight bearing, lacer, non-molded           Thigh/wght bear lacer non-mo38      A                                                                                                     C                          D1F P      01986010119960101        N
L2540001003Addition  to lower extremity, thigh/weight bearing, lacer, molded to patient    Thigh/wght bear lacer molded38      A                                                                                                     C                          D1F P      01986010119960101        N
L2540002004model
L2550001003Addition  to lower extremity, thigh/weight bearing, high roll cuff              Thigh/wght bear high roll cu38      A                                                                                                     C                          D1F P      01986010119960101        N
L2570002003Addition to lower extremity, pelvic control, hip joint, clevis type two         Hip clevis type 2 posit jnt 38      A                                                                                                     C                          D1F P      01986010119960101        N
L2570003004position joint, each
L2580001003Addition to lower extremity, pelvic control, pelvic sling                       Pelvic control pelvic sling 38      A                                                                                                     C                          D1F P      01986010119960101        N
L2600001003Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust  Hip clevis/thrust bearing fr38      A                                                                                                     C                          D1F P      01986010119960101        N
L2600002004bearing, free, each
L2610001003Addition to lower extremity, pelvic control, hip joint, clevis or thrust        Hip clevis/thrust bearing lo38      A                                                                                                     C                          D1F P      01986010119960101        N
L2610002004bearing, lock, each
L2620001003Addition to lower extremity, pelvic control, hip joint, heavy duty, each        Pelvic control hip heavy dut38      A                                                                                                     C                          D1F P      01986010119960101        N
L2622001003Addition to lower extremity, pelvic control, hip joint, adjustable flexion, eachHip joint adjustable flexion38      A                                                                                                     C                          D1F P      01988010119960101        N
L2624001003Addition to lower extremity, pelvic control, hip joint, adjustable flexion,     Hip adj flex ext abduct cont38      A                                                                                                     C                          D1F P      01988010119960101        N
L2624002004extension, abduction control, each
L2627001003Addition to lower extremity, pelvic control, plastic, molded to patient model,  Plastic mold recipro hip & c38      A                                                                                                     C                          D1F P      01989010119960101        N
L2627002004reciprocating hip joint and cables
L2628001003Addition to lower extremity, pelvic control, metal frame, reciprocating hip     Metal frame recipro hip & ca38      A                                                                                                     C                          D1F P      01989010119960101        N
L2628002004joint and cables
L2630001003Addition to lower extremity, pelvic control, band and belt, unilateral          Pelvic control band & belt u38      A                                                                                                     C                          D1F P      01986010119960101        N
L2640001003Addition to lower extremity, pelvic control, band and belt, bilateral           Pelvic control band & belt b38      A                                                                                                     C                          D1F P      01986010119960101        N
L2650001003Addition to lower extremity, pelvic and thoracic control, gluteal pad, each     Pelv & thor control gluteal 38      A                                                                                                     C                          D1F P      01986010119960101        N
L2660001003Addition to lower extremity, thoracic control, thoracic band                    Thoracic control thoracic ba38      A                                                                                                     C                          D1F P      01986010119960101        N
L2670001003Addition to lower extremity, thoracic control, paraspinal uprights              Thorac cont paraspinal uprig38      A                                                                                                     C                          D1F P      01986010119960101        N
L2680001003Addition to lower extremity, thoracic control, lateral support uprights         Thorac cont lat support upri38      A                                                                                                     C                          D1F P      01986010119960101        N
L2750002003Addition to lower extremity orthosis, plating chrome or nickel, per bar         Plating chrome/nickel pr bar38      A                                                                                                     C                          D1F P      01986010119960101        N
L2755001003Addition to lower extremity orthosis, high strength, lightweight material, all  Carbon graphite lamination  38      A                                                                                                     C                          D1F P      01997010120050101        N
L2755002004hybrid lamination/prepreg composite, per segment, for custom fabricated
L2755003004orthosis only
L2760001003Addition to lower extremity orthosis, extension, per extension, per bar (for    Extension per extension per 38      A                                                                                                     C                          D1F P      01986010119960101        N
L2760002004lineal adjustment for growth)
L2768001003Orthotic side bar disconnect device, per bar                                    Ortho sidebar disconnect    38      A                                                                                                     C                          D1F P      02002010120020101        N
L2770001003Addition to lower extremity orthosis, any material - per bar or joint           Low ext orthosis per bar/jnt38      A                                                                                                     C                          D1F P      0198601012010010120091231N
L2780001003Addition to lower extremity orthosis, non-corrosive finish, per bar             Non-corrosive finish        38      A                                                                                                     C                          D1F P      01986010119960101        N
L2785001003Addition to lower extremity orthosis, drop lock retainer, each                  Drop lock retainer each     38      A                                                                                                     C                          D1F P      01988010119960101        N
L2795001003Addition to lower extremity orthosis, knee control, full kneecap                Knee control full kneecap   38      A                                                                                                     C                          D1F P      01988010119960101        N
L2800001003Addition to lower extremity orthosis, knee control, knee cap, medial or lateral Knee cap medial or lateral p38      A                                                                                                     C                          D1F P      01988010120050101        N
L2800002004pull, for use with custom fabricated orthosis only
L2810001003Addition to lower extremity orthosis, knee control, condylar pad                Knee control condylar pad   38      A                                                                                                     C                          D1F P      01988010119960101        N
L2820001003Addition to lower extremity orthosis, soft interface for molded plastic, below  Soft interface below knee se38      A                                                                                                     C                          D1F P      01988010119960101        N
L2820002004knee section
L2830001003Addition to lower extremity orthosis, soft interface for molded plastic, above  Soft interface above knee se38      A                                                                                                     C                          D1F P      01988010119960101        N
L2830002004knee section
L2840001003Addition to lower extremity orthosis, tibial length sock, fracture or equal,    Tibial length sock fx or equ38      A                                                                                                     C                          D1F P      01989010119960101        N
L2840002004each
L2850001003Addition to lower extremity orthosis, femoral length sock, fracture or equal,   Femoral lgth sock fx or equa38      A                                                                                                     C                          D1F P      01989010119960101        N
L2850002004each
L2861001003Addition to lower extremity joint, knee or ankle, concentric adjustable torsion Torsion mechanism knee/ankle00      9                                                                                                     I                          D1F P      02010010120100101        N
L2861002004style mechanism for custom fabricated orthotics only, each
L2999001003Lower extremity orthoses, not otherwise specified                               Lower extremity orthosis NOS46      A                                                                                                     C                          D1F P      01982010119980101        N
L3000003003Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell,   Ft insert ucb berkeley shell00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3000004004each
L3001001003Foot, insert, removable, molded to patient model, spenco, each                  Foot insert remov molded spe00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3002001003Foot, insert, removable, molded to patient model, plastazote or equal, each     Foot insert plastazote or eq00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3003001003Foot, insert, removable, molded to patient model, silicone gel, each            Foot insert silicone gel eac00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3010001003Foot, insert, removable, molded to patient model, longitudinal arch support,    Foot longitudinal arch suppo00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3010002004each
L3020001003Foot, insert, removable, molded to patient model, longitudinal/ metatarsal      Foot longitud/metatarsal sup00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3020002004support, each
L3030001003Foot, insert, removable, formed to patient foot, each                           Foot arch support remov prem00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3031001003Foot, insert/plate, removable, addition to lower extremity orthosis, high       Foot lamin/prepreg composite00      9                                                                                                     C                          D1F P      02004010120050101        N
L3031002004strength, lightweight material, all hybrid lamination/prepreg composite, each
L3040002003Foot, arch support, removable, premolded, longitudinal, each                    Ft arch suprt premold longit00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3050001003Foot, arch support, removable, premolded, metatarsal, each                      Foot arch supp premold metat00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3060001003Foot, arch support, removable, premolded, longitudinal/ metatarsal, each        Foot arch supp longitud/meta00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3070002003Foot, arch support, non-removable attached to shoe, longitudinal, each          Arch suprt att to sho longit00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3080001003Foot, arch support, non-removable attached to shoe, metatarsal, each            Arch supp att to shoe metata00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3090001003Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal,    Arch supp att to shoe long/m00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3090002004each
L3100001003Hallus-valgus night dynamic splint                                              Hallus-valgus nght dynamic s00      9                  2323                                                                               D                          D1F P      01985010119970101        N
L3140002003Foot, abduction rotation bar, including shoes                                   Abduction rotation bar shoe 00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3150001003Foot, abduction rotatation bar, without shoes                                   Abduct rotation bar w/o shoe00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3160001003Foot, adjustable shoe-styled positioning device                                 Shoe styled positioning dev 00      9                                                                                                     C                          D1F P      01986010119950101        N
L3170001003Foot, plastic, silicone or equal,  heel stabilizer, each                        Foot plastic heel stabilizer00      9                  2323                                                                               D                          D1F P      01984010120060101        N
L3201002003Orthopedic shoe, oxford with supinator or pronator, infant                      Oxford w supinat/pronat inf 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3202001003Orthopedic shoe, oxford with supinator or pronator, child                       Oxford w/ supinat/pronator c00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3203001003Orthopedic shoe, oxford with supinator or pronator, junior                      Oxford w/ supinator/pronator00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3204001003Orthopedic shoe, hightop with supinator or pronator, infant                     Hightop w/ supp/pronator inf00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3206001003Orthopedic shoe, hightop with supinator or pronator, child                      Hightop w/ supp/pronator chi00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3207001003Orthopedic shoe, hightop with supinator or pronator, junior                     Hightop w/ supp/pronator jun00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3208001003Surgical boot, each, infant                                                     Surgical boot each infant   00      9                  2079                                                                               D                          D1F P      01984010119960101        N
L3209001003Surgical boot, each, child                                                      Surgical boot each child    00      9                  2079                                                                               D                          D1F P      01984010119960101        N
L3211001003Surgical boot, each, junior                                                     Surgical boot each junior   00      9                  2079                                                                               D                          D1F P      01984010119960101        N
L3212001003Benesch boot, pair, infant                                                      Benesch boot pair infant    00      9                  2079                                                                               D                          D1F P      01984010119960101        N
L3213001003Benesch boot, pair, child                                                       Benesch boot pair child     00      9                  2079                                                                               D                          D1F P      01984010119960101        N
L3214001003Benesch boot, pair, junior                                                      Benesch boot pair junior    00      9                  2079                                                                               D                          D1F P      01984010119960101        N
L3215001003Orthopedic footwear, ladies shoe, oxford, each                                  Orthopedic ftwear ladies oxf00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N
L3216001003Orthopedic footwear, ladies shoe, depth inlay, each                             Orthoped ladies shoes dpth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N
L3217001003Orthopedic footwear, ladies shoe, hightop, depth inlay, each                    Ladies shoes hightop depth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N
L3219001003Orthopedic footwear, mens shoe, oxford, each                                    Orthopedic mens shoes oxford00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N
L3221001003Orthopedic footwear, mens shoe, depth inlay, each                               Orthopedic mens shoes dpth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N
L3222001003Orthopedic footwear, mens shoe, hightop, depth inlay, each                      Mens shoes hightop depth inl00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N
L3224001003Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace  Woman's shoe oxford brace   38      A                  2323D                                                                              D                          D1F P      01995010119950101        N
L3224002004(orthosis)
L3225001003Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace    Man's shoe oxford brace     38      A                  2323D                                                                              D                          D1F P      01995010119950101        N
L3225002004(orthosis)
L3230001003Orthopedic footwear, custom shoe, depth inlay, each                             Custom shoes depth inlay    00      9                  2323                                                                               D                          D1F P      01984010120060101        N
L3250001003Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, Custom mold shoe remov prost00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3250002004each
L3251001003Foot, shoe molded to patient model, silicone shoe, each                         Shoe molded to pt silicone s00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3252001003Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, Shoe molded plastazote cust 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3252002004each
L3253001003Foot, molded shoe plastazote (or similar) custom fitted, each                   Shoe molded plastazote cust 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3254001003Non-standard size or width                                                      Orth foot non-stndard size/w00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3255001003Non-standard size or length                                                     Orth foot non-standard size/00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3257001003Orthopedic footwear, additional charge for split size                           Orth foot add charge split s00      9                  2323                                                                               D                          D1F P      01988010119970101        N
L3260001003Surgical boot/shoe, each                                                        Ambulatory surgical boot eac00      9                  2079                                                                               D                          D1F P      01984010120030101        N
L3265001003Plastazote sandal, each                                                         Plastazote sandal each      00      9                                                                                                     C                          D1F P      01984010119960101        N
L3300003003Lift, elevation, heel, tapered to metatarsals, per inch                         Sho lift taper to metatarsal00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3310001003Lift, elevation, heel and sole, neoprene, per inch                              Shoe lift elev heel/sole neo00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3320001003Lift, elevation, heel and sole, cork, per inch                                  Shoe lift elev heel/sole cor00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3330001003Lift, elevation, metal extension (skate)                                        Lifts elevation metal extens00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3332001003Lift, elevation, inside shoe, tapered, up to one-half inch                      Shoe lifts tapered to one-ha00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3334001003Lift, elevation, heel, per inch                                                 Shoe lifts elevation heel /i00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3340002003Heel wedge, sach                                                                Shoe wedge sach             00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3350001003Heel wedge                                                                      Shoe heel wedge             00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3360001003Sole wedge, outside sole                                                        Shoe sole wedge outside sole00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3370001003Sole wedge, between sole                                                        Shoe sole wedge between sole00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3380001003Clubfoot wedge                                                                  Shoe clubfoot wedge         00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3390001003Outflare wedge                                                                  Shoe outflare wedge         00      9                  2323                                                                               D                          D1F P      01982010119970101        N
L3400001003Metatarsal bar wedge, rocker                                                    Shoe metatarsal bar wedge ro00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3410001003Metatarsal bar wedge, between sole                                              Shoe metatarsal bar between 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3420001003Full sole and heel wedge, between sole                                          Full sole/heel wedge btween 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3430002003Heel, counter, plastic reinforced                                               Sho heel count plast reinfor00      9                  2323                                                                               D                          D1F P      01985010119970101        N
L3440001003Heel, counter, leather reinforced                                               Heel leather reinforced     00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3450001003Heel, sach cushion type                                                         Shoe heel sach cushion type 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3455001003Heel, new leather, standard                                                     Shoe heel new leather standa00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3460001003Heel, new rubber, standard                                                      Shoe heel new rubber standar00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3465001003Heel, thomas with wedge                                                         Shoe heel thomas with wedge 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3470001003Heel, thomas extended to ball                                                   Shoe heel thomas extend to b00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3480001003Heel, pad and depression for spur                                               Shoe heel pad & depress for 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3485001003Heel, pad, removable for spur                                                   Shoe heel pad removable for 00      9                  2323                                                                               D                          D1F P      01984010119970101        N
L3500002003Orthopedic shoe addition, insole, leather                                       Ortho shoe add leather insol00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3510001003Orthopedic shoe addition, insole, rubber                                        Orthopedic shoe add rub insl00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3520001003Orthopedic shoe addition, insole, felt covered with leather                     O shoe add felt w leath insl00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3530001003Orthopedic shoe addition, sole, half                                            Ortho shoe add half sole    00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3540001003Orthopedic shoe addition, sole, full                                            Ortho shoe add full sole    00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3550001003Orthopedic shoe addition, toe tap standard                                      O shoe add standard toe tap 00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3560001003Orthopedic shoe addition, toe tap, horseshoe                                    O shoe add horseshoe toe tap00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3570001003Orthopedic shoe addition, special extension to instep (leather with eyelets)    O shoe add instep extension 00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3580001003Orthopedic shoe addition, convert instep to velcro closure                      O shoe add instep velcro clo00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3590001003Orthopedic shoe addition, convert firm shoe counter to soft counter             O shoe convert to sof counte00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3595001003Orthopedic shoe addition, march bar                                             Ortho shoe add march bar    00      9                  2323                                                                               D                          D1F P      01986010119990101        N
L3600002003Transfer  of an orthosis from one shoe to another, caliper plate, existing      Trans shoe calip plate exist00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3610001003Transfer  of an orthosis from one shoe to another, caliper plate, new           Trans shoe caliper plate new00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3620001003Transfer  of an orthosis from one shoe to another, solid stirrup, existing      Trans shoe solid stirrup exi00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3630001003Transfer  of an orthosis from one shoe to another, solid stirrup, new           Trans shoe solid stirrup new00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3640001003Transfer  of an orthosis from one shoe to another, dennis browne splint         Shoe dennis browne splint bo00      9                  2323                                                                               D                          D1F P      01986010119970101        N
L3640002004(riveton), both shoes
L3649001003Orthopedic shoe, modification, addition or transfer, not otherwise specified    Orthopedic shoe modifica NOS00      9                  2323                                                                               D                          D1F P      01982010119990101        N
L3650010003Shoulder orthosis, figure of eight design abduction restrainer, prefabricated,  Shlder fig 8 abduct restrain38      A                                                                                                     C                          D1F P      01986010120010101        N
L3650011004includes fitting and adjustment
L3651001003Shoulder orthosis, single shoulder, elastic, prefabricated, includes fitting    Prefab shoulder orthosis    38      A                                                                                                     C                          D1F P      0200301012010010120091231N
L3651002004and adjustment (e. G. Neoprene, lycra)
L3652001003Shoulder orthosis, double shoulder, elastic, prefabricated, includes fitting    Prefab dbl shoulder orthosis38      A                                                                                                     C                          D1F P      0200301012010010120091231N
L3652002004and adjustment (e. G. Neoprene, lycra)
L3660001003Shoulder orthosis, figure of eight design abduction restrainer, canvas and      Abduct restrainer canvas&web38      A                                                                                                     C                          D1F P      01982010120010101        N
L3660002004webbing, prefabricated, includes fitting and adjustment
L3670001003Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, Acromio/clavicular canvas&we38      A                                                                                                     C                          D1F P      01982010120010101        N
L3670002004includes fitting and adjustment
L3671001003Shoulder orthosis, shoulder joint design, without joints, may include soft      SO cap design w/o jnts CF   38      A                                                                                                     C                          D1F P      02006010120110101        N
L3671002004interface, straps, custom fabricated, includes fitting and adjustment
L3672001003Shoulder orthosis, abduction positioning (airplane design), thoracic component  SO airplane w/o jnts CF     38      A                                                                                                     C                          D1F P      0200601012011010120101231N
L3672002004and support bar, without joints, may inlcude soft interface, straps, custom
L3672003004fabricated, includes fitting and adjustment
L3673001003Shoulder orthosis, abduction positioning (airplane design), thoracic component  SO airplane w/joint CF      38      A                                                                                                     C                          D1F P      0200601012011010120101231N
L3673002004and support bar, includes nontorsion joint/turnbuckle, may include soft
L3673003004interface, straps, custom fabricated, includes fitting and adjustment
L3674001003Shoulder orthosis, abduction positioning (airplane design), thoracic component  SO airplane w/wo joint CF   38      A                                                                                                     C                          D1F P      02011010120110101        N
L3674002004and support bar, with or without nontorsion joint/turnbuckle, may include soft
L3674003004interface, straps, custom fabricated, includes fitting and adjustment
L3675001003Shoulder orthosis, vest type abduction restrainer, canvas webbing type or       Canvas vest SO              38      A                                                                                                     C                          D1F P      01999010120010101        N
L3675002004equal, prefabricated, includes fitting and adjustment
L3677001003Shoulder orthosis, shoulder joint design, without joints, may include soft      SO hard plastic stabilizer  00      9                  2130                                                                               D                          Z2  P      02002010120110101        N
L3677002004interface, straps, prefabricated, includes fitting and adjustment
L3700002003Elbow orthosis, elastic with stays, prefabricated, includes fitting and         Elbow orthoses elas w stays 38      A                                                                                                     C                          D1F P      0198201012010010120091231N
L3700003004adjustment
L3701001003Elbow orthosis, elastic, prefabricated, includes fitting and adjustment (e. G.  Prefab elbow orthosis       38      A                                                                                                     C                          D1F P      0200301012010010120091231N
L3701002004Neoprene, lycra)
L3702001003Elbow orthosis, without joints, may include soft interface, straps, custom      EO w/o joints CF            38      A                                                                                                     C                          D1F P      02006010120060101        N
L3702002004fabricated, includes fitting and adjustment
L3710001003Elbow orthosis, elastic with metal joints, prefabricated, includes fitting and  Elbow elastic with metal joi38      A                                                                                                     C                          D1F P      01986010120010101        N
L3710002004adjustment
L3720001003Elbow orthosis, double upright with forearm/arm cuffs, free motion,             Forearm/arm cuffs free motio38      A                                                                                                     C                          D1F P      01984010120010101        N
L3720002004custom-fabricated
L3730001003Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion       Forearm/arm cuffs ext/flex a38      A                                                                                                     C                          D1F P      01982010120010101        N
L3730002004assist, custom-fabricated
L3740001003Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock Cuffs adj lock w/ active con38      A                                                                                                     C                          D1F P      01982010120010101        N
L3740002004with active control, custom-fabricated
L3760001003Elbow orthosis, with adjustable position locking joint(s), prefabricated,       EO withjoint, Prefabricated 38      A                                                                                                     C                          D1F P      02001010120010101        N
L3760002004includes fitting and adjustments, any type
L3762001003Elbow orthosis, rigid, without joints, includes soft interface material,        Rigid EO wo joints          38      A                                                                                                     C                          D1F P      02003010120030101        N
L3762002004prefabricated, includes fitting and adjustment
L3763001003Elbow wrist hand orthosis, rigid, without joints, may include soft interface,   EWHO rigid w/o jnts CF      38      A                                                                                                     C                          D1F P      02006010120060101        N
L3763002004straps, custom fabricated, includes fitting and adjustment
L3764001003Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic      EWHO w/joint(s) CF          38      A                                                                                                     C                          D1F P      02006010120060101        N
L3764002004bands, turnbuckles, may include soft interface, straps, custom fabricated,
L3764003004includes fitting and adjustment
L3765001003Elbow wrist hand finger orthosis, rigid, without joints, may include soft       EWHFO rigid w/o jnts CF     38      A                                                                                                     C                          D1F P      02006010120060101        N
L3765002004interface, straps, custom fabricated, includes fitting and adjustment
L3766001003Elbow wrist hand finger orthosis, includes one or more nontorsion joints,       EWHFO w/joint(s) CF         38      A                                                                                                     C                          D1F P      02006010120060101        N
L3766002004elastic bands, turnbuckles, may include soft interface, straps, custom
L3766003004fabricated, includes fitting and adjustment
L3806001003Wrist hand finger orthosis, includes one or more nontorsion joint(s),           WHFO w/joint(s) custom fab  38      A                                                                                                     C                          D1F P      02007010120080101        N
L3806002004turnbuckles, elastic bands/springs, may include soft interface material,
L3806003004straps, custom fabricated, includes fitting and adjustment
L3807001003Wrist hand finger orthosis, without joint(s), prefabricated, includes fitting   WHFO,no joint, prefabricated38      A                                                                                                     C                          D1F P      02000010120010101        N
L3807002004and adjustments, any type
L3808001003Wrist hand finger orthosis, rigid without joints, may include soft interface    WHFO, rigid w/o joints      38      A                                                                                                     C                          D1F P      02007010120070101        N
L3808002004material; straps, custom fabricated, includes fitting and adjustment
L3891001003Addition to upper extremity joint, wrist or elbow, concentric adjustable        Torsion mechanism wrist/elbo00      9                                                                                                     I                          D1F P      02010010120100101        N
L3891002004torsion style mechanism for custom fabricated orthotics only, each
L3900001003Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/   Hinge extension/flex wrist/f38      A                                                                                                     C                          D1F P      01986010120010101        N
L3900002004flexion, finger flexion/extension, wrist or finger driven, custom-fabricated
L3901001003Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/   Hinge ext/flex wrist finger 38      A                                                                                                     C                          D1F P      01984010120010101        N
L3901002004flexion, finger flexion/extension, cable driven, custom-fabricated
L3904001003Wrist hand finger orthosis, external powered, electric, custom-fabricated       Whfo electric custom fitted 38      A                                                                                                     C                          D1F P      01982010120010101        N
L3905001003Wrist hand orthosis, includes one or more nontorsion joints, elastic bands,     WHO w/nontorsion jnt(s) CF  38      A                                                                                                     C                          D1F P      02006010120060101        N
L3905002004turnbuckles, may include soft interface, straps, custom fabricated, includes
L3905003004fitting and adjustment
L3906002003Wrist hand orthosis, without joints, may include soft interface, straps, custom WHO w/o joints CF           38      A                                                                                                     C                          D1F P      01986010120060101        N
L3906003004fabricated, includes fitting and adjustment
L3908001003Wrist hand orthosis, wrist extension control cock-up, non molded,               Wrist cock-up non-molded    38      A                                                                                                     C                          D1F P      01986010120010101        N
L3908002004prefabricated, includes fitting and adjustment
L3909001003Wrist orthosis, elastic, prefabricated, includes fitting and adjustment (e. G.  Prefab wrist orthosis       38      A                                                                                                     C                          D1F P      0200301012010010120091231N
L3909002004Neoprene, lycra)
L3911001003Wrist hand finger orthosis, elastic, prefabricated, includes fitting and        Prefab hand finger orthosis 38      A                                                                                                     C                          D1F P      0200301012010010120091231N
L3911002004adjustment (e. G. Neoprene, lycra)
L3912001003Hand finger orthosis, flexion glove with elastic finger control, prefabricated, Flex glove w/elastic finger 38      A                                                                                                     C                          D1F P      01982010120010101        N
L3912002004includes fitting and adjustment
L3913001003Hand finger orthosis, without joints, may include soft interface, straps,       HFO w/o joints CF           38      A                                                                                                     C                          D1F P      02006010120060101        N
L3913002004custom fabricated, includes fitting and adjustment
L3915001003Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands,   WHO w nontor jnt(s) prefab  38      A                                                                                                     C                          D1F P      02007010120070101        N
L3915002004turnbuckles, may include soft interface, straps, prefabricated, includes
L3915003004fitting and adjustment
L3917001003Hand orthosis, metacarpal fracture orthosis, prefabricated, includes fitting    Prefab metacarpl fx orthosis38      A                                                                                                     C                          D1F P      02004010120040101        N
L3917002004and adjustment
L3919001003Hand orthosis, without joints, may include soft interface, straps, custom       HO w/o joints CF            38      A                                                                                                     C                          D1F P      02006010120060101        N
L3919002004fabricated, includes fitting and adjustment
L3921001003Hand finger orthosis, includes one or more nontorsion joints, elastic bands,    HFO w/joint(s) CF           38      A                                                                                                     C                          D1F P      02006010120060101        N
L3921002004turnbuckles, may include soft interface, straps, custom fabricated, includes
L3921003004fitting and adjustment
L3923001003Hand finger orthosis, without joints, may include soft interface, straps,       HFO w/o joints PF           38      A                                                                                                     C                          D1F P      02001010120060101        N
L3923002004prefabricated, includes fitting and adjustment
L3925001003Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip),   FO pip/dip with joint/spring38      A                                                                                                     C                          D1F P      02008010120080101        N
L3925002004non torsion joint/spring, extension/flexion, may include soft interface
L3925003004material, prefabricated, includes fitting and adjustment
L3927001003Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip),   FO pip/dip w/o joint/spring 38      A                                                                                                     C                          D1F P      02008010120080101        N
L3927002004without joint/spring, extension/flexion (e. G. Static or ring type), may
L3927003004include soft interface material, prefabricated, includes fitting and adjustment
L3929001003Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles,    HFO nontorsion joint, prefab38      A                                                                                                     C                          D1F P      02008010120080101        N
L3929002004elastic bands/springs, may include soft interface material, straps,
L3929003004prefabricated, includes fitting and adjustment
L3931001003Wrist hand finger orthosis, includes one or more nontorsion joint(s),           WHFO nontorsion joint prefab38      A                                                                                                     C                          D1F P      02008010120080101        N
L3931002004turnbuckles, elastic bands/springs, may include soft interface material,
L3931003004straps, prefabricated, includes fitting and adjustment
L3933001003Finger orthosis, without joints, may include soft interface, custom fabricated, FO w/o joints CF            38      A                                                                                                     C                          D1F P      02006010120060101        N
L3933002004includes fitting and adjustment
L3935001003Finger orthosis, nontorsion joint, may include soft interface, custom           FO nontorsion joint CF      38      A                                                                                                     C                          D1F P      02006010120060101        N
L3935002004fabricated, includes fitting and adjustment
L3956001003Addition of joint to upper extremity orthosis, any material; per joint          Add joint upper ext orthosis38      A                                                                                                     C                          D1F P      01997010119970101        N
L3960003003Shoulder elbow wrist hand orthosis, abduction positioning, airplane design,     Sewho airplan desig abdu pos38      A                                                                                                     C                          D1F P      01986010120010101        N
L3960004004prefabricated, includes fitting and adjustment
L3961001003Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may    SEWHO cap design w/o jnts CF38      A                                                                                                     C                          D1F P      02006010120060101        N
L3961002004include soft interface, straps, custom fabricated, includes fitting and
L3961003004adjustment
L3962001003Shoulder elbow wrist hand orthosis, abduction positioning, erbs palsey design,  Sewho erbs palsey design abd38      A                                                                                                     C                          D1F P      01982010120010101        N
L3962002004prefabricated, includes fitting and adjustment
L3964001003Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced,   Seo mobile arm sup att to wc32      A                                                                            E2626                    C                          D1D APR    0198601012012010120111231N
L3964002004adjustable, prefabricated, includes fitting and adjustment
L3965001003Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced,   Arm supp att to wc rancho ty32      A                                                                            E2627                    C                          D1D APR    0198401012012010120111231N
L3965002004adjustable rancho type, prefabricated, includes fitting and adjustment
L3966001003Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced,   Mobile arm supports reclinin32      A                                                                            E2628                    C                          D1D APR    0198601012012010120111231N
L3966002004reclining, prefabricated, includes fitting and adjustment
L3967001003Shoulder elbow wrist hand orthosis, abduction positioning (airplane design),    SEWHO airplane w/o jnts CF  38      A                                                                                                     C                          D1F P      02006010120060101        N
L3967002004thoracic component and support bar, without joints, may include soft interface,
L3967003004straps, custom fabricated, includes fitting and adjustment
L3968001003Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced,   Friction dampening arm supp 32      A                                                                            E2629                    C                          D1D APR    0198601012012010120111231N
L3968002004friction arm support (friction dampening to proximal and distal joints),
L3968003004prefabricated, includes fitting and adjustment
L3969001003Shoulder elbow orthosis, mobile arm support, monosuspension arm and hand        Monosuspension arm/hand supp32      A                                                                            E2630                    C                          D1D APR    0198801012012010120111231N
L3969002004support, overhead elbow forearm hand sling support, yoke type suspension
L3969003004support, prefabricated, includes fitting and adjustment
L3970002003Seo, addition to mobile arm support, elevating proximal arm                     Elevat proximal arm support 32      A                                                                            E2631                    C                          D1D APR    0198601012012010120111231N
L3971001003Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more   SEWHO cap design w/jnt(s) CF38      A                                                                                                     C                          D1F P      02006010120060101        N
L3971002004nontorsion joints, elastic bands, turnbuckles, may include soft interface,
L3971003004straps, custom fabricated, includes fitting and adjustment
L3972001003Seo, addition to mobile arm support, offset or lateral rocker arm with elastic  Offset/lat rocker arm w/ ela32      A                                                                            E2632                    C                          D1D APR    0198601012012010120111231N
L3972002004balance control
L3973001003Shoulder elbow wrist hand orthosis, abduction positioning (airplane design),    SEWHO airplane w/jnt(s) CF  38      A                                                                                                     C                          D1F P      02006010120060101        N
L3973002004thoracic component and support bar, includes one or more nontorsion joints,
L3973003004elastic bands, turnbuckles, may include soft interface, straps, custom
L3973004004fabricated, includes fitting and adjustment
L3974001003Seo, addition to mobile arm support, supinator                                  Mobile arm support supinator32      A                                                                            E2633                    C                          D1D APR    0198601012012010120111231N
L3975001003Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, SEWHFO cap design w/o jnt CF38      A                                                                                                     C                          D1F P      02006010120060101        N
L3975002004may include soft interface, straps, custom fabricated, includes fitting and
L3975003004adjustment
L3976001003Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane      SEWHFO airplane w/o jnts CF 38      A                                                                                                     C                          D1F P      02006010120060101        N
L3976002004design), thoracic component and support bar, without joints, may include soft
L3976003004interface, straps, custom fabricated, includes fitting and adjustment
L3977001003Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or SEWHFO cap desgn w/jnt(s) CF38      A                                                                                                     C                          D1F P      02006010120060101        N
L3977002004more nontorsion joints, elastic bands, turnbuckles, may include soft interface,
L3977003004straps, custom fabricated, includes fitting and adjustment
L3978001003Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane      SEWHFO airplane w/jnt(s) CF 38      A                                                                                                     C                          D1F P      02006010120060101        N
L3978002004design), thoracic component and support bar, includes one or more nontorsion
L3978003004joints, elastic bands, turnbuckles, may include soft interface, straps, custom
L3978004004fabricated, includes fitting and adjustment
L3980002003Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and Upp ext fx orthosis humeral 38      A                                                                                                     C                          D1F P      01982010120010101        N
L3980003004adjustment
L3982001003Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes        Upper ext fx orthosis rad/ul38      A                                                                                                     C                          D1F P      01984010120010101        N
L3982002004fitting and adjustment
L3984001003Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and   Upper ext fx orthosis wrist 38      A                                                                                                     C                          D1F P      01982010120010101        N
L3984002004adjustment
L3995001003Addition to upper extremity orthosis, sock, fracture or equal, each             Sock fracture or equal each 38      A                                                                                                     C                          D1F P      01989010119960101        N
L3999001003Upper limb orthosis, not otherwise specified                                    Upper limb orthosis NOS     46      A                                                                                                     C                          D1F P      01982010119980101        N
L4000002003Replace girdle for spinal orthosis (ctlso or so)                                Repl girdle milwaukee orth  38      A                                                                                                     C                          D1F P      01985010120020101        N
L4002001003Replacement strap, any orthosis, includes all components, any length, any type  Replace strap, any orthosis 38      A                                                                                                     C                          D1F P      02005010120050101        N
L4010001003Replace trilateral socket brim                                                  Replace trilateral socket br38      A                                                                                                     C                          D1F P      01985010119960101        N
L4020001003Replace quadrilateral socket brim, molded to patient model                      Replace quadlat socket brim 38      A                                                                                                     C                          D1F P      01985010119960101        N
L4030001003Replace quadrilateral socket brim, custom fitted                                Replace socket brim cust fit38      A                                                                                                     C                          D1F P      01985010119960101        N
L4040001003Replace molded thigh lacer, for custom fabricated orthosis only                 Replace molded thigh lacer  38      A                                                                                                     C                          D1F P      01985010120050101        N
L4045001003Replace non-molded thigh lacer, for custom fabricated orthosis only             Replace non-molded thigh lac38      A                                                                                                     C                          D1F P      01988010120050101        N
L4050001003Replace molded calf lacer, for custom fabricated orthosis only                  Replace molded calf lacer   38      A                                                                                                     C                          D1F P      01985010120050101        N
L4055001003Replace non-molded calf lacer, for custom fabricated orthosis only              Replace non-molded calf lace38      A                                                                                                     C                          D1F P      01988010120050101        N
L4060001003Replace high roll cuff                                                          Replace high roll cuff      38      A                                                                                                     C                          D1F P      01985010119960101        N
L4070001003Replace proximal and distal upright for kafo                                    Replace prox & dist upright 38      A                                                                                                     C                          D1F P      01986010119960101        N
L4080001003Replace metal bands kafo, proximal thigh                                        Repl met band kafo-afo prox 38      A                                                                                                     C                          D1F P      01986010119960101        N
L4090001003Replace metal bands kafo-afo, calf or distal thigh                              Repl met band kafo-afo calf/38      A                                                                                                     C                          D1F P      01985010119960101        N
L4100001003Replace leather cuff kafo, proximal thigh                                       Repl leath cuff kafo prox th38      A                                                                                                     C                          D1F P      01986010119960101        N
L4110001003Replace leather cuff kafo-afo, calf or distal thigh                             Repl leath cuff kafo-afo cal38      A                                                                                                     C                          D1F P      01985010119960101        N
L4130001003Replace pretibial shell                                                         Replace pretibial shell     38      A                                                                                                     C                          D1F P      01984010119960101        N
L4205001003Repair of orthotic device, labor component, per 15 minutes                      Ortho dvc repair per 15 min 46      A                  2100.4                                                                             D                          D1F P      01997010119970101        N
L4210001003Repair of orthotic device, repair or replace minor parts                        Orth dev repair/repl minor p46      A                  2133    2100.4  2130D                                                              D                          D1F P      01985010119960101        N
L4350001003Ankle control orthosis, stirrup style, rigid, includes any type interface (e.   Ankle control orthosi prefab38      A                                                                                                     C                          D1F P      01989010120040101        N
L4350002004G. , pneumatic, gel),  prefabricated, includes fitting and adjustment
L4360001003Walking boot, pneumatic and/or vacuum, with or without joints, with or without  Pneumati walking boot prefab38      A                                                                                                     C                          D1F P      01989010120090101        N
L4360002004interface material, prefabricated, includes fitting and adjustment
L4370001003Pneumatic full leg splint, prefabricated, includes fitting and adjustment       Pneumatic full leg splint   38      A                                                                                                     C                          D1F P      01989010120030101        N
L4380001003Pneumatic knee splint, prefabricated, includes fitting and adjustment           Pneumatic knee splint       38      A                                                                                                     C                          D1F P      0198901012012010120111231N
L4386001003Walking boot, non-pneumatic, with or without joints, with or without interface  Non-pneum walk boot prefab  38      A                                                                                                     C                          D1F P      02003010120040101        N
L4386002004material, prefabricated, includes fitting and adjustment
L4392001003Replacement, soft interface material, static afo                                Replace AFO soft interface  38      A                                                                                                     C                          D1F P      01997010120010101        N
L4394001003Replace soft interface material, foot drop splint                               Replace foot drop spint     38      A                                                                                                     C                          D1F P      01997010119970101        N
L4396001003Static or dynamic ankle foot orthosis, including soft interface material,       Static AFO                  38      A                                                                                                     C                          D1F P      01997010120100101        N
L4396002004adjustable for fit, for  positioning, may be used for minimal ambulation,
L4396003004prefabricated, includes fitting and adjustment
L4398001003Foot drop splint, recumbent positioning device, prefabricated, includes fitting Foot drop splint recumbent  38      A                                                                                                     C                          D1F P      01997010120010101        N
L4398002004and adjustment
L4631001003Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, Afo, walk boot type, cus fab38      A                                                                                                     C                          D1F P      02011010120110101        N
L4631002004anterior tibial shell, soft interface, custom arch support, plastic or other
L4631003004material, includes straps and closures, custom fabricated
L5000010003Partial foot, shoe insert with longitudinal arch, toe filler                    Sho insert w arch toe filler38      A                  2323                                                                               D                          D1F P      01982010119960101        N
L5010001003Partial foot, molded socket, ankle height, with toe filler                      Mold socket ank hgt w/ toe f38      A                  2323                                                                               D                          D1F P      01982010119960101        N
L5020001003Partial foot, molded socket, tibial tubercle height, with toe filler            Tibial tubercle hgt w/ toe f38      A                  2323                                                                               D                          D1F P      01982010119960101        N
L5050002003Ankle, symes, molded socket, sach foot                                          Ank symes mold sckt sach ft 38      A                                                                                                     C                          D1F P      01985010119960101        N
L5060001003Ankle, symes, metal frame, molded leather socket, articulated ankle/foot        Symes met fr leath socket ar38      A                                                                                                     C                          D1F P      01985010119960101        N
L5100002003Below knee, molded socket, shin, sach foot                                      Molded socket shin sach foot38      A                                                                                                     C                          D1F P      01982010119960101        N
L5105001003Below knee, plastic socket, joints and thigh lacer, sach foot                   Plast socket jts/thgh lacer 38      A                                                                                                     C                          D1F P      01989010119960101        N
L5150002003Knee disarticulation (or through knee), molded socket, external knee joints,    Mold sckt ext knee shin sach38      A                                                                                                     C                          D1F P      01982010119960101        N
L5150003004shin, sach foot
L5160001003Knee disarticulation (or through knee), molded socket, bent knee configuration, Mold socket bent knee shin s38      A                                                                                                     C                          D1F P      01982010119960101        N
L5160002004external knee joints, shin, sach foot
L5200002003Above knee, molded socket, single axis constant friction knee, shin, sach foot  Kne sing axis fric shin sach38      A                                                                                                     C                          D1F P      01982010119960101        N
L5210001003Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no  No knee/ankle joints w/ ft b38      A                                                                                                     C                          D1F P      01982010119960101        N
L5210002004ankle joints, each
L5220001003Above knee, short prosthesis, no knee joint ('stubbies'), with articulated      No knee joint with artic ali38      A                                                                                                     C                          D1F P      01982010119960101        N
L5220002004ankle/foot, dynamically aligned, each
L5230001003Above knee, for proximal femoral focal deficiency, constant friction knee,      Fem focal defic constant fri38      A                                                                                                     C                          D1F P      01982010119960101        N
L5230002004shin, sach foot
L5250002003Hip disarticulation, canadian type; molded socket, hip joint, single axis       Hip canad sing axi cons fric38      A                                                                                                     C                          D1F P      01982010119960101        N
L5250003004constant friction knee, shin, sach foot
L5270001003Hip disarticulation, tilt table type; molded socket, locking hip joint, single  Tilt table locking hip sing 38      A                                                                                                     C                          D1F P      01982010119960101        N
L5270002004axis constant friction knee, shin, sach foot
L5280002003Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant   Hemipelvect canad sing axis 38      A                                                                                                     C                          D1F P      01982010119960101        N
L5280003004friction knee, shin, sach foot
L5301001003Below knee, molded socket, shin, sach foot, endoskeletal system                 BK mold socket SACH ft endo 38      A                                                                                                     C                          D1F P      02002010120020101        N
L5311001003Knee disarticulation (or through knee), molded socket, external knee joints,    Knee disart, SACH ft, endo  38      A                                                                                                     C                          D1F P      0200201012012010120111231N
L5311002004shin, sach foot, endoskeletal system
L5312001003Knee disarticulation (or through knee), molded socket, single axis knee, pylon, Knee disart, SACH ft, endo  38      A                                                                                                     C                          D1F P      02012010120120101        N
L5312002004sach foot, endoskeletal system
L5321001003Above knee, molded socket, open end, sach foot, endoskeletal system, single     AK open end SACH            38      A                                                                                                     C                          D1F P      02002010120020101        N
L5321002004axis knee
L5331001003Hip disarticulation, canadian type, molded socket, endoskeletal system, hip     Hip disart canadian SACH ft 38      A                                                                                                     C                          D1F P      02002010120020101        N
L5331002004joint, single axis knee, sach foot
L5341001003Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint,   Hemipelvectomy canadian SACH38      A                                                                                                     C                          D1F P      02002010120020101        N
L5341002004single axis knee, sach foot
L5400003003Immediate post surgical or early fitting, application of initial rigid          Postop dress & 1 cast chg bk38      A                                                                                                     C                          D1F P      01982010119960101        N
L5400004004dressing, including fitting, alignment, suspension, and one cast change, below
L5400005004knee
L5410001003Immediate post surgical or early fitting, application of initial rigid          Postop dsg bk ea add cast ch38      A                                                                                                     C                          D1F P      01986010119960101        N
L5410002004dressing, including fitting, alignment and suspension, below knee, each
L5410003004additional cast change and realignment
L5420001003Immediate post surgical or early fitting, application of initial rigid          Postop dsg & 1 cast chg ak/d38      A                                                                                                     C                          D1F P      01982010119960101        N
L5420002004dressing, including fitting, alignment and suspension and one cast change 'ak'
L5420003004or knee disarticulation
L5430001003Immediate post surgical or early fitting, application of initial rigid          Postop dsg ak ea add cast ch38      A                                                                                                     C                          D1F P      01986010119960101        N
L5430002004dressing, incl. Fitting, alignment and supension, 'ak' or knee disarticulation,
L5430003004each additional cast change and realignment
L5450001003Immediate post surgical or early fitting, application of non-weight bearing     Postop app non-wgt bear dsg 38      A                                                                                                     C                          D1F P      01982010119960101        N
L5450002004rigid dressing, below knee
L5460001003Immediate post surgical or early fitting, application of non-weight bearing     Postop app non-wgt bear dsg 38      A                                                                                                     C                          D1F P      01982010119960101        N
L5460002004rigid dressing, above knee
L5500002003Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover,   Init bk ptb plaster direct  38      A                                                                                                     C                          D1F P      01986010119960101        N
L5500003004sach foot, plaster socket, direct formed
L5505001003Initial, above knee - knee disarticulation, ischial level socket, non-alignable Init ak ischal plstr direct 38      A                                                                                                     C                          D1F P      01986010119960101        N
L5505002004system, pylon, no cover, sach foot, plaster socket, direct formed
L5510002003Preparatory, below knee  'ptb'  type socket, non-alignable system, pylon, no    Prep BK ptb plaster molded  38      A                                                                                                     C                          D1F P      01986010119960101        N
L5510003004cover, sach foot, plaster socket, molded to model
L5520001003Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no      Perp BK ptb thermopls direct38      A                                                                                                     C                          D1F P      01986010119960101        N
L5520002004cover, sach foot, thermoplastic or equal, direct formed
L5530001003Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no      Prep BK ptb thermopls molded38      A                                                                                                     C                          D1F P      01986010119960101        N
L5530002004cover, sach foot, thermoplastic or equal, molded to model
L5535001003Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach Prep BK ptb open end socket 38      A                                                                                                     C                          D1F P      01989010119960101        N
L5535002004foot, prefabricated, adjustable open end socket
L5540001003Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no      Prep BK ptb laminated socket38      A                                                                                                     C                          D1F P      01986010119960101        N
L5540002004cover, sach foot, laminated socket, molded to model
L5560001003Preparatory, above knee- knee disarticulation, ischial level socket,            Prep AK ischial plast molded38      A                                                                                                     C                          D1F P      01986010119960101        N
L5560002004non-alignable system, pylon, no cover, sach foot, plaster socket, molded to
L5560003004model
L5570001003Preparatory, above knee - knee disarticulation, ischial level socket,           Prep AK ischial direct form 38      A                                                                                                     C                          D1F P      01986010119960101        N
L5570002004non-alignable system, pylon, no cover, sach foot, thermoplastic or equal,
L5570003004direct formed
L5580001003Preparatory, above knee - knee disarticulation ischial level socket,            Prep AK ischial thermo mold 38      A                                                                                                     C                          D1F P      01986010119960101        N
L5580002004non-alignable system, pylon, no cover, sach foot, thermoplastic or equal,
L5580003004molded to model
L5585001003Preparatory, above knee - knee disarticulation, ischial level socket,           Prep AK ischial open end    38      A                                                                                                     C                          D1F P      01988010119960101        N
L5585002004non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open
L5585003004end socket
L5590001003Preparatory, above knee - knee disarticulation ischial level socket,            Prep AK ischial laminated   38      A                                                                                                     C                          D1F P      01986010119960101        N
L5590002004non-alignable system, pylon no cover, sach foot,  laminated socket, molded to
L5590003004model
L5595001003Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot,    Hip disartic sach thermopls 38      A                                                                                                     C                          D1F P      01989010119960101        N
L5595002004thermoplastic or equal, molded to patient model
L5600002003Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot,    Hip disart sach laminat mold38      A                                                                                                     C                          D1F P      01989010119960101        N
L5600003004laminated socket, molded to patient model
L5610001003Addition to lower extremity, endoskeletal system, above knee, hydracadence      Above knee hydracadence     38      A                                                                                                     C                          D1F P      01986010119960101        N
L5610002004system
L5611001003Addition to lower extremity, endoskeletal system, above knee - knee             Ak 4 bar link w/fric swing  38      A                                                                                                     C                          D1F P      01989010119960101        N
L5611002004disarticulation, 4 bar linkage, with friction swing phase control
L5613001003Addition to lower extremity, endoskeletal system, above knee-knee               Ak 4 bar ling w/hydraul swig38      A                                                                                                     C                          D1F P      01989010119960101        N
L5613002004disarticulation, 4 bar linkage, with hydraulic swing phase control
L5614001003Addition to lower extremity, exoskeletal system, above knee-knee                4-bar link above knee w/swng38      A                                                                                                     C                          D1F P      01994010119960101        N
L5614002004disarticulation, 4 bar linkage, with pneumatic swing phase control
L5616001003Addition to lower extremity, endoskeletal system, above knee, universal         Ak univ multiplex sys frict 38      A                                                                                                     C                          D1F P      01986010119960101        N
L5616002004multiplex system, friction swing phase control
L5617001003Addition to lower extremity, quick change self-aligning unit, above knee or     AK/BK self-aligning unit ea 38      A                                                                                                     C                          D1F P      01996010119960101        N
L5617002004below knee, each
L5618002003Addition to lower extremity, test socket, symes                                 Test socket symes           38      A                                                                                                     C                          D1F P      01986010119960101        N
L5620001003Addition to lower extremity, test socket, below knee                            Test socket below knee      38      A                                                                                                     C                          D1F P      01986010119960101        N
L5622001003Addition to lower extremity, test socket, knee disarticulation                  Test socket knee disarticula38      A                                                                                                     C                          D1F P      01986010119960101        N
L5624001003Addition to lower extremity, test socket, above knee                            Test socket above knee      38      A                                                                                                     C                          D1F P      01986010119960101        N
L5626001003Addition to lower extremity, test socket, hip disarticulation                   Test socket hip disarticulat38      A                                                                                                     C                          D1F P      01986010119960101        N
L5628001003Addition to lower extremity, test socket, hemipelvectomy                        Test socket hemipelvectomy  38      A                                                                                                     C                          D1F P      01986010119960101        N
L5629001003Addition to lower extremity, below knee, acrylic socket                         Below knee acrylic socket   38      A                                                                                                     C                          D1F P      01989010119960101        N
L5630002003Addition to lower extremity, symes type, expandable wall socket                 Syme typ expandabl wall sckt38      A                                                                                                     C                          D1F P      01986010119960101        N
L5631001003Addition to lower extremity, above knee or knee disarticulation, acrylic socket Ak/knee disartic acrylic soc38      A                                                                                                     C                          D1F P      01989010119960101        N
L5632001003Addition to lower extremity, symes type,  'ptb' brim design socket              Symes type ptb brim design s38      A                                                                                                     C                          D1F P      01986010119960101        N
L5634001003Addition to lower extremity, symes type, posterior opening (canadian) socket    Symes type poster opening so38      A                                                                                                     C                          D1F P      01986010119960101        N
L5636001003Addition  to lower extremity, symes type, medial opening socket                 Symes type medial opening so38      A                                                                                                     C                          D1F P      01986010119960101        N
L5637001003Addition to lower extremity, below knee, total contact                          Below knee total contact    38      A                                                                                                     C                          D1F P      01989010119960101        N
L5638001003Addition  to lower extremity, below knee, leather socket                        Below knee leather socket   38      A                                                                                                     C                          D1F P      01986010119960101        N
L5639001003Addition to lower extremity, below knee, wood socket                            Below knee wood socket      38      A                                                                                                     C                          D1F P      01989010119960101        N
L5640001003Addition  to lower extremity, knee disarticulation, leather socket              Knee disarticulat leather so38      A                                                                                                     C                          D1F P      01986010119960101        N
L5642001003Addition  to lower extremity, above knee, leather socket                        Above knee leather socket   38      A                                                                                                     C                          D1F P      01986010119960101        N
L5643001003Addition  to lower extremity, hip disarticulation, flexible inner socket,       Hip flex inner socket ext fr38      A                                                                                                     C                          D1F P      01988010119960101        N
L5643002004external frame
L5644001003Addition  to lower extremity, above knee, wood socket                           Above knee wood socket      38      A                                                                                                     C                          D1F P      01986010119960101        N
L5645001003Addition  to lower extremity, below knee, flexible inner socket, external frame Bk flex inner socket ext fra38      A                                                                                                     C                          D1F P      01988010120001213        N
L5646001003Addition  to lower extremity, below knee, air, fluid, gel or equal, cushion     Below knee cushion socket   38      A                                                                                                     C                          D1F P      01986010120040101        N
L5646002004socket
L5647001003Addition  to lower extremity, below knee suction socket                         Below knee suction socket   38      A                                                                                                     C                          D1F P      01988010119960101        N
L5648001003Addition  to lower extremity, above knee, air, fluid, gel or equal,  cushion    Above knee cushion socket   38      A                                                                                                     C                          D1F P      01986010120040101        N
L5648002004socket
L5649001003Addition  to lower extremity, ischial containment/narrow m-l socket             Isch containmt/narrow m-l so38      A                                                                                                     C                          D1F P      01988010119960101        N
L5650001003Additions to lower extremity, total contact, above knee or knee disarticulation Tot contact ak/knee disart s38      A                                                                                                     C                          D1F P      01986010119960101        N
L5650002004socket
L5651001003Addition  to lower extremity, above knee, flexible inner socket, external frame Ak flex inner socket ext fra38      A                                                                                                     C                          D1F P      01988010119960101        N
L5652001003Addition  to lower extremity, suction suspension, above knee or knee            Suction susp ak/knee disart 38      A                                                                                                     C                          D1F P      01986010119960101        N
L5652002004disarticulation socket
L5653001003Addition  to lower extremity, knee disarticulation, expandable wall socket      Knee disart expand wall sock38      A                                                                                                     C                          D1F P      01986010119960101        N
L5654002003Addition  to lower extremity, socket insert, symes, (kemblo, pelite, aliplast,  Socket insert symes         38      A                                                                                                     C                          D1F P      01986010119960101        N
L5654003004plastazote or equal)
L5655001003Addition  to lower extremity, socket insert, below knee (kemblo, pelite,        Socket insert below knee    38      A                                                                                                     C                          D1F P      01986010119960101        N
L5655002004aliplast, plastazote or equal)
L5656001003Addition  to lower extremity, socket insert, knee disarticulation (kemblo,      Socket insert knee articulat38      A                                                                                                     C                          D1F P      01986010119960101        N
L5656002004pelite, aliplast, plastazote or equal)
L5658001003Addition  to lower extremity, socket insert, above knee (kemblo, pelite,        Socket insert above knee    38      A                                                                                                     C                          D1F P      01986010119960101        N
L5658002004aliplast, plastazote or equal)
L5661001003Addition  to lower extremity, socket insert, multi-durometer symes              Multi-durometer symes       38      A                                                                                                     C                          D1F P      01988010119960101        N
L5665001003Addition  to lower extremity, socket insert, multi-durometer, below knee        Multi-durometer below knee  38      A                                                                                                     C                          D1F P      01988010119960101        N
L5666001003Addition  to lower extremity, below knee, cuff suspension                       Below knee cuff suspension  38      A                                                                                                     C                          D1F P      01986010119960101        N
L5668001003Addition  to lower extremity, below knee, molded distal cushion                 Socket insert w/o lock lower38      A                                                                                                     C                          D1F P      01986010119960101        N
L5670001003Addition  to lower extremity, below knee, molded supracondylar suspension       Bk molded supracondylar susp38      A                                                                                                     C                          D1F P      01986010119960101        N
L5670002004('pts' or similar)
L5671001003Addition to lower extremity, below knee / above knee suspension locking         BK/AK locking mechanism     38      A                                                                                                     C                          D1F P      02002010120020101        N
L5671002004mechanism (shuttle, lanyard or equal), excludes socket insert
L5672001003Addition  to lower extremity, below knee, removable medial brim suspension      Bk removable medial brim sus38      A                                                                                                     C                          D1F P      01986010119960101        N
L5673001003Addition to lower extremity, below knee/above knee, custom fabricated from      Socket insert w lock mech   38      A                                                                                                     C                          D1F P      02004010120040101        N
L5673002004existing mold or prefabricated, socket insert, silicone gel, elastomeric or
L5673003004equal, for use with locking mechanism
L5676001003Additions to lower extremity, below knee, knee joints, single axis, pair        Bk knee joints single axis p38      A                                                                                                     C                          D1F P      01986010119960101        N
L5677001003Additions to lower extremity, below knee, knee joints, polycentric, pair        Bk knee joints polycentric p38      A                                                                                                     C                          D1F P      01988010119960101        N
L5678001003Additions to lower extremity, below knee, joint covers, pair                    Bk joint covers pair        38      A                                                                                                     C                          D1F P      01984010119960101        N
L5679001003Addition to lower extremity, below knee/above knee, custom fabricated from      Socket insert w/o lock mech 38      A                                                                                                     C                          D1F P      02004010120040101        N
L5679002004existing mold or prefabricated, socket insert, silicone gel, elastomeric or
L5679003004equal, not for use with locking mechanism
L5680001003Addition  to lower extremity, below knee, thigh lacer, nonmolded                Bk thigh lacer non-molded   38      A                                                                                                     C                          D1F P      01986010119960101        N
L5681001003Addition to lower extremity, below knee/above knee, custom fabricated socket    Intl custm cong/latyp insert38      A                                                                                                     C                          D1F P      02004010120040101        N
L5681002004insert for congenital or atypical traumatic amputee, silicone gel, elastomeric
L5681003004or equal, for use with or without locking mechanism, initial only (for other
L5681004004than initial, use code l5673 or l5679)
L5682001003Addition  to lower extremity, below knee, thigh lacer, gluteal/ischial, molded  Bk thigh lacer glut/ischia m38      A                                                                                                     C                          D1F P      01986010119960101        N
L5683001003Addition to lower extremity, below knee/above knee, custom fabricated socket    Initial custom socket insert38      A                                                                                                     C                          D1F P      02004010120040101        N
L5683002004insert for other than congenital or atypical traumatic amputee, silicone gel,
L5683003004elastomeric or equal, for use with or without locking mechanism, initial only
L5683004004(for other than initial, use code l5673 or l5679)
L5684001003Addition  to lower extremity, below knee, fork strap                            Bk fork strap               38      A                                                                                                     C                          D1F P      01986010119960101        N
L5685001003Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve,  Below knee sus/seal sleeve  38      A                                                                                                     C                          D1F P      02005010120050101        N
L5685002004with or without valve, any material, each
L5686001003Addition  to lower extremity, below knee, back check (extension control)        Bk back check               38      A                                                                                                     C                          D1F P      01986010119960101        N
L5688001003Addition  to lower extremity, below knee, waist belt, webbing                   Bk waist belt webbing       38      A                                                                                                     C                          D1F P      01986010119960101        N
L5690001003Addition  to lower extremity, below knee, waist belt, padded and lined          Bk waist belt padded and lin38      A                                                                                                     C                          D1F P      01986010119960101        N
L5692001003Addition  to lower extremity, above knee, pelvic control belt, light            Ak pelvic control belt light38      A                                                                                                     C                          D1F P      01986010119960101        N
L5694001003Addition  to lower extremity, above knee, pelvic control belt, padded and lined Ak pelvic control belt pad/l38      A                                                                                                     C                          D1F P      01986010119960101        N
L5695001003Addition to lower extremity, above knee, pelvic control, sleeve suspension,     Ak sleeve susp neoprene/equa38      A                                                                                                     C                          D1F P      01989010119960101        N
L5695002004neoprene or equal, each
L5696001003Addition  to lower extremity, above knee or knee disarticulation, pelvic joint  Ak/knee disartic pelvic join38      A                                                                                                     C                          D1F P      01986010119960101        N
L5697001003Addition  to lower extremity, above knee or knee disarticulation, pelvic band   Ak/knee disartic pelvic band38      A                                                                                                     C                          D1F P      01986010119960101        N
L5698001003Addition  to lower extremity, above knee or knee disarticulation, silesian      Ak/knee disartic silesian ba38      A                                                                                                     C                          D1F P      01986010119960101        N
L5698002004bandage
L5699001003All lower extremity prostheses, shoulder harness                                Shoulder harness            38      A                                                                                                     C                          D1F P      01986010119960101        N
L5700002003Replacement, socket, below knee, molded to patient model                        Replace socket below knee   38      A                                                                                                     C                          D1F P      01994010119940101        N
L5701001003Replacement, socket, above knee/knee disarticulation, including attachment      Replace socket above knee   38      A                                                                                                     C                          D1F P      01994010119940101        N
L5701002004plate, molded to patient model
L5702001003Replacement, socket, hip disarticulation, including hip joint, molded to        Replace socket hip          38      A                                                                                                     C                          D1F P      01994010119940101        N
L5702002004patient model
L5703001003Ankle, symes, molded to patient model, socket without solid ankle cushion heel  Symes ankle w/o (SACH) foot 38      A                                                                                                     C                          D1F P      02006010120060101        N
L5703002004(sach) foot, replacement only
L5704001003Custom shaped protective cover, below knee                                      Custom shape cover BK       38      A                                                                                                     C                          D1F P      01994010120020101        N
L5705001003Custom shaped protective cover, above knee                                      Custom shape cover AK       38      A                                                                                                     C                          D1F P      01994010120020101        N
L5706001003Custom shaped protective cover, knee disarticulation                            Custom shape cvr knee disart38      A                                                                                                     C                          D1F P      01994010120020101        N
L5707001003Custom shaped protective cover, hip disarticulation                             Custom shape cvr hip disart 38      A                                                                                                     C                          D1F P      01994010120020101        N
L5710003003Addition,  exoskeletal knee-shin system, single axis, manual lock               Kne-shin exo sng axi mnl loc38      A                                                                                                     C                          D1F P      01986010119960101        N
L5711001003Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light   Knee-shin exo mnl lock ultra38      A                                                                                                     C                          D1F P      01988010119960101        N
L5711002004material
L5712001003Addition,  exoskeletal knee-shin system, single axis, friction swing and stance Knee-shin exo frict swg & st38      A                                                                                                     C                          D1F P      01986010119960101        N
L5712002004phase control (safety knee)
L5714001003Addition,  exoskeletal knee-shin system, single axis, variable friction swing   Knee-shin exo variable frict38      A                                                                                                     C                          D1F P      01986010119960101        N
L5714002004phase control
L5716001003Addition,  exoskeletal knee-shin system, polycentric, mechanical stance phase   Knee-shin exo mech stance ph38      A                                                                                                     C                          D1F P      01986010119960101        N
L5716002004lock
L5718001003Addition,  exoskeletal knee-shin system, polycentric,  friction swing and       Knee-shin exo frct swg & sta38      A                                                                                                     C                          D1F P      01986010119960101        N
L5718002004stance phase control
L5722001003Addition,  exoskeletal knee-shin system, single axis, pneumatic swing, friction Knee-shin pneum swg frct exo38      A                                                                                                     C                          D1F P      01986010119960101        N
L5722002004stance phase control
L5724001003Addition,  exoskeletal knee-shin system, single axis, fluid swing phase control Knee-shin exo fluid swing ph38      A                                                                                                     C                          D1F P      01986010119960101        N
L5726001003Addition,  exoskeletal knee-shin system, single axis, external joints fluid     Knee-shin ext jnts fld swg e38      A                                                                                                     C                          D1F P      01986010119960101        N
L5726002004swing phase control
L5728001003Addition,  exoskeletal knee-shin system, single axis, fluid swing and stance    Knee-shin fluid swg & stance38      A                                                                                                     C                          D1F P      01986010119960101        N
L5728002004phase control
L5780001003Addition,  exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic Knee-shin pneum/hydra pneum 38      A                                                                                                     C                          D1F P      01986010119960101        N
L5780002004swing phase control
L5781001003Addition to lower limb prosthesis, vacuum pump, residual limb volume management Lower limb pros vacuum pump 38      A                                                                                                     C                          D1F P      02003010120030101        N
L5781002004and moisture evacuation system
L5782001003Addition to lower limb prosthesis, vacuum pump, residual limb volume management HD low limb pros vacuum pump38      A                                                                                                     C                          D1F P      02003010120030101        N
L5782002004and moisture evacuation system, heavy duty
L5785002003Addition, exoskeletal system, below knee, ultra-light material (titanium,       Exoskeletal bk ultralt mater38      A                                                                                                     C                          D1F P      01988010119960101        N
L5785003004carbon fiber or equal)
L5790001003Addition, exoskeletal system, above knee, ultra-light material (titanium,       Exoskeletal ak ultra-light m38      A                                                                                                     C                          D1F P      01988010119960101        N
L5790002004carbon fiber or equal)
L5795001003Addition, exoskeletal system, hip disarticulation, ultra-light material         Exoskel hip ultra-light mate38      A                                                                                                     C                          D1F P      01988010119960101        N
L5795002004(titanium, carbon fiber or equal)
L5810002003Addition, endoskeletal knee-shin system, single axis, manual lock               Endoskel knee-shin mnl lock 38      A                                                                                                     C                          D1F P      01988010119960101        N
L5811001003Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light  Endo knee-shin mnl lck ultra38      A                                                                                                     C                          D1F P      01988010119960101        N
L5811002004material
L5812001003Addition, endoskeletal knee-shin system, single axis, friction swing and stance Endo knee-shin frct swg & st38      A                                                                                                     C                          D1F P      01988010119960101        N
L5812002004phase control (safety knee)
L5814001003Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase     Endo knee-shin hydral swg ph38      A                                                                                                     C                          D1F P      01997010119970101        N
L5814002004control, mechanical stance phase lock
L5816001003Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase   Endo knee-shin polyc mch sta38      A                                                                                                     C                          D1F P      01988010119960101        N
L5816002004lock
L5818001003Addition, endoskeletal knee-shin system, polycentric, friction swing, and       Endo knee-shin frct swg & st38      A                                                                                                     C                          D1F P      01988010119960101        N
L5818002004stance phase control
L5822001003Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction Endo knee-shin pneum swg frc38      A                                                                                                     C                          D1F P      01988010119960101        N
L5822002004stance phase control
L5824001003Addition, endoskeletal knee-shin system, single axis, fluid swing phase control Endo knee-shin fluid swing p38      A                                                                                                     C                          D1F P      01988010119960101        N
L5826001003Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase     Miniature knee joint        38      A                                                                                                     C                          D1F P      01998010119990101        N
L5826002004control, with miniature high activity frame
L5828001003Addition, endoskeletal knee-shin system, single axis, fluid swing and stance    Endo knee-shin fluid swg/sta38      A                                                                                                     C                          D1F P      01988010119960101        N
L5828002004phase control
L5830001003Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase    Endo knee-shin pneum/swg pha38      A                                                                                                     C                          D1F P      01988010119960101        N
L5830002004control
L5840001003Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic Multi-axial knee/shin system38      A                                                                                                     C                          D1F P      01994010119990101        N
L5840002004swing phase control
L5845001003Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable    Knee-shin sys stance flexion38      A                                                                                                     C                          D1F P      01996010119960101        N
L5848001003Addition to endoskeletal knee-shin system, fluid stance extension, dampening    Knee-shin sys hydraul stance38      A                                                                                                     C                          D1F P      02003010120070101        N
L5848002004feature, with or without adjustability
L5850001003Addition,  endoskeletal system, above knee or hip disarticulation, knee         Endo ak/hip knee extens assi38      A                                                                                                     C                          D1F P      01988010119960101        N
L5850002004extension assist
L5855001003Addition, endoskeletal system, hip disarticulation, mechanical hip extension    Mech hip extension assist   38      A                                                                                                     C                          D1F P      01994010119950101        N
L5855002004assist
L5856001003Addition to lower extremity prosthesis, endoskeletal knee-shin system,          Elec knee-shin swing/stance 38      A                                                                                                     C                          D1F P      02005010120050101        N
L5856002004microprocessor control feature, swing and stance phase, includes electronic
L5856003004sensor(s), any type
L5857001003Addition to lower extremity prosthesis, endoskeletal knee-shin system,          Elec knee-shin swing only   38      A                                                                                                     C                          D1F P      02005010120050101        N
L5857002004microprocessor control feature, swing phase only, includes electronic
L5857003004sensor(s), any type
L5858001003Addition to lower extremity prosthesis, endoskeletal knee shin system,          Stance phase only           38      A                                                                                                     C                          D1F P      02006010120060101        N
L5858002004microprocessor control feature, stance phase only, includes electronic
L5858003004sensor(s), any type
L5859001003Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered  Knee-shin pro flex/ext cont 38      A                                                                                                     C                          D1F P      02013010120130101        A
L5859002004and programmable flexion/extension assist control, includes any type motor(s)
L5910001003Addition,  endoskeletal system, below knee, alignable system                    Endo below knee alignable sy38      A                                                                                                     C                          D1F P      01988010119960101        N
L5920001003Addition, endoskeletal system, above knee or hip disarticulation, alignable     Endo ak/hip alignable system38      A                                                                                                     C                          D1F P      01988010119960101        N
L5920002004system
L5925001003Addition, endoskeletal system, above knee, knee disarticulation or hip          Above knee manual lock      38      A                                                                                                     C                          D1F P      01994010120000101        N
L5925002004disarticulation, manual lock
L5930001003Addition, endoskeletal system, high activity knee control frame                 High activity knee frame    38      A                                                                                                     C                          D1F P      01996010119960101        N
L5940001003Addition,  endoskeletal system, below knee, ultra-light material (titanium,     Endo bk ultra-light material38      A                                                                                                     C                          D1F P      01988010119960101        N
L5940002004carbon fiber or equal)
L5950001003Addition,  endoskeletal system, above knee, ultra-light material (titanium,     Endo ak ultra-light material38      A                                                                                                     C                          D1F P      01988010119960101        N
L5950002004carbon fiber or equal)
L5960001003Addition,  endoskeletal system, hip disarticulation, ultra-light material       Endo hip ultra-light materia38      A                                                                                                     C                          D1F P      01988010119960101        N
L5960002004(titanium, carbon fiber or equal)
L5961001003Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic    Endo poly hip, pneu/hyd/rot 38      A                                                                                                     C                          D1F P      02011010120110101        N
L5961002004control, rotation control, with or without flexion and/or extension control
L5962001003Addition, endoskeletal system, below knee, flexible protective outer surface    Below knee flex cover system38      A                                                                                                     C                          D1F P      01994010119940101        N
L5962002004covering system
L5964001003Addition, endoskeletal system, above knee, flexible protective outer surface    Above knee flex cover system38      A                                                                                                     C                          D1F P      01994010119940101        N
L5964002004covering system
L5966001003Addition, endoskeletal system, hip disarticulation, flexible protective outer   Hip flexible cover system   38      A                                                                                                     C                          D1F P      01994010119940101        N
L5966002004surface covering system
L5968001003Addition to lower limb prosthesis, multiaxial ankle with swing phase active     Multiaxial ankle w dorsiflex38      A                                                                                                     C                          D1F P      01999010120000101        N
L5968002004dorsiflexion feature
L5970001003All lower extremity prostheses, foot, external keel, sach foot                  Foot external keel sach foot38      A                                                                                                     C                          D1F P      01989010119960101        N
L5971001003All lower extremity prosthesis, solid ankle cushion heel (sach) foot,           SACH foot, replacement      38      A                                                                                                     C                          D1F P      02006010120060101        N
L5971002004replacement only
L5972001003All lower extremity prostheses, foot, flexible keel                             Flexible keel foot          38      A                                                                                                     C                          D1F P      01989010120130101        C
L5973001003Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion Ank-foot sys dors-plant flex38      A                                                                                                     C                          D1F P      02010010120100101        N
L5973002004and/or plantar flexion control, includes power source
L5974001003All lower extremity prostheses, foot, single axis ankle/foot                    Foot single axis ankle/foot 38      A                                                                                                     C                          D1F P      01989010119960101        N
L5975001003All lower extremity prosthesis, combination single axis ankle and flexible keel Combo ankle/foot prosthesis 38      A                                                                                                     C                          D1F P      01999010119990101        N
L5975002004foot
L5976001003All lower extremity prostheses, energy storing foot (seattle carbon copy ii or  Energy storing foot         38      A                                                                                                     C                          D1F P      01989010119960101        N
L5976002004equal)
L5978001003All lower extremity prostheses, foot, multiaxial ankle/foot                     Ft prosth multiaxial ankl/ft38      A                                                                                                     C                          D1F P      01989010119960101        N
L5979001003All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one   Multi-axial ankle/ft prosth 38      A                                                                                                     C                          D1F P      01994010120010101        N
L5979002004piece system
L5980001003All lower extremity prostheses, flex foot system                                Flex foot system            38      A                                                                                                     C                          D1F P      01989010119960101        N
L5981001003All lower extremity prostheses, flex-walk system or equal                       Flex-walk sys low ext prosth38      A                                                                                                     C                          D1F P      01994010119940101        N
L5982001003All exoskeletal lower extremity prostheses, axial rotation unit                 Exoskeletal axial rotation u38      A                                                                                                     C                          D1F P      01989010119960101        N
L5984001003All endoskeletal lower extremity prosthesis, axial rotation unit, with or       Endoskeletal axial rotation 38      A                                                                                                     C                          D1F P      01989010120040101        N
L5984002004without adjustability
L5985001003All endoskeletal lower extremity prostheses, dynamic prosthetic pylon           Lwr ext dynamic prosth pylon38      A                                                                                                     C                          D1F P      01996010119960101        N
L5986001003All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)      Multi-axial rotation unit   38      A                                                                                                     C                          D1F P      01989010119960101        N
L5987001003All lower extremity prosthesis, shank foot system with vertical loading pylon   Shank ft w vert load pylon  38      A                                                                                                     C                          D1F P      01997010119970101        N
L5988001003Addition to lower limb prosthesis, vertical shock reducing pylon feature        Vertical shock reducing pylo38      A                                                                                                     C                          D1F P      01999010120000101        N
L5990001003Addition to lower extremity prosthesis, user adjustable heel height             User adjustable heel height 38      A                                                                                                     C                          D1F P      02002010120020101        N
L5999001003Lower extremity prosthesis, not otherwise specified                             Lowr extremity prosthes NOS 46      A                                                                                                     C                          D1F P      01982010119980101        N
L6000007003Partial hand, thumb remaining                                                   Part hand thumb rem         38      A                                                                                                     C                          D1F P      01982010120120101        N
L6010001003Partial hand, little and/or ring finger remaining                               Part hand little/ring       38      A                                                                                                     C                          D1F P      01982010120120101        N
L6020001003Partial hand, no finger remaining                                               Part hand no fingers        38      A                                                                                                     C                          D1F P      01982010120120101        N
L6025001003Transcarpal/metacarpal or partial hand disarticulation prosthesis, external     Part hand disart myoelectric38      A                                                                                                     C                          D1F P      02003010120030101        N
L6025002004power, self-suspended, inner socket with removable forearm section, electrodes
L6025003004and cables, two batteries, charger, myoelectric control of terminal device
L6050002003Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad        Wrst MLd sck flx hng tri pad38      A                                                                                                     C                          D1F P      01982010119960101        N
L6055001003Wrist disarticulation, molded socket with expandable interface, flexible elbow  Wrst mold sock w/exp interfa38      A                                                                                                     C                          D1F P      01988010119960101        N
L6055002004hinges, triceps pad
L6100002003Below elbow, molded socket, flexible elbow hinge, triceps pad                   Elb mold sock flex hinge pad38      A                                                                                                     C                          D1F P      01982010119960101        N
L6110001003Below elbow, molded socket, (muenster or northwestern suspension types)         Elbow mold sock suspension t38      A                                                                                                     C                          D1F P      01982010119960101        N
L6120001003Below elbow, molded double wall split socket, step-up hinges, half cuff         Elbow mold doub splt soc ste38      A                                                                                                     C                          D1F P      01982010119960101        N
L6130001003Below elbow, molded double wall split socket, stump activated locking hinge,    Elbow stump activated lock h38      A                                                                                                     C                          D1F P      01982010119960101        N
L6130002004half cuff
L6200002003Elbow disarticulation, molded socket, outside locking hinge, forearm            Elbow mold outsid lock hinge38      A                                                                                                     C                          D1F P      01982010119960101        N
L6205001003Elbow disarticulation, molded socket with expandable interface, outside locking Elbow molded w/ expand inter38      A                                                                                                     C                          D1F P      01988010119960101        N
L6205002004hinges, forearm
L6250002003Above elbow, molded double wall socket, internal locking elbow, forearm         Elbow inter loc elbow forarm38      A                                                                                                     C                          D1F P      01982010119960101        N
L6300002003Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section,    Shlder disart int lock elbow38      A                                                                                                     C                          D1F P      01982010119960101        N
L6300003004internal locking elbow, forearm
L6310001003Shoulder disarticulation, passive restoration (complete prosthesis)             Shoulder passive restor comp38      A                                                                                                     C                          D1F P      01982010119960101        N
L6320001003Shoulder disarticulation, passive restoration (shoulder cap only)               Shoulder passive restor cap 38      A                                                                                                     C                          D1F P      01982010119960101        N
L6350002003Interscapular thoracic, molded socket, shoulder bulkhead, humeral section,      Thoracic intern lock elbow  38      A                                                                                                     C                          D1F P      01984010119960101        N
L6350003004internal locking elbow, forearm
L6360001003Interscapular thoracic, passive restoration (complete prosthesis)               Thoracic passive restor comp38      A                                                                                                     C                          D1F P      01986010119960101        N
L6370001003Interscapular thoracic, passive restoration (shoulder cap only)                 Thoracic passive restor cap 38      A                                                                                                     C                          D1F P      01986010119960101        N
L6380002003Immediate post surgical or early fitting, application of initial rigid          Postop dsg cast chg wrst/elb38      A                                                                                                     C                          D1F P      01988010119960101        N
L6380003004dressing, including fitting alignment and suspension of components, and one
L6380004004cast change, wrist disarticulation or below elbow
L6382001003Immediate post surgical or early fitting, application of initial rigid dressing Postop dsg cast chg elb dis/38      A                                                                                                     C                          D1F P      01988010119960101        N
L6382002004including fitting alignment and suspension of components, and one cast change,
L6382003004elbow disarticulation or above elbow
L6384001003Immediate post surgical or early fitting, application of initial rigid dressing Postop dsg cast chg shlder/t38      A                                                                                                     C                          D1F P      01988010119960101        N
L6384002004including fitting alignment and suspension of components, and one cast change,
L6384003004shoulder disarticulation or interscapular thoracic
L6386001003Immediate post surgical or early fitting, each additional cast change and       Postop ea cast chg & realign38      A                                                                                                     C                          D1F P      01988010119960101        N
L6386002004realignment
L6388001003Immediate post surgical or early fitting, application of rigid dressing only    Postop applicat rigid dsg on38      A                                                                                                     C                          D1F P      01988010119960101        N
L6400002003Below elbow, molded socket, endoskeletal system, including soft prosthetic      Below elbow prosth tiss shap38      A                                                                                                     C                          D1F P      01982010119960101        N
L6400003004tissue shaping
L6450002003Elbow disarticulation, molded socket, endoskeletal system, including soft       Elb disart prosth tiss shap 38      A                                                                                                     C                          D1F P      01982010119960101        N
L6450003004prosthetic tissue shaping
L6500002003Above elbow, molded socket, endoskeletal system, including soft prosthetic      Above elbow prosth tiss shap38      A                                                                                                     C                          D1F P      01982010119960101        N
L6500003004tissue shaping
L6550002003Shoulder disarticulation, molded socket, endoskeletal system, including soft    Shldr disar prosth tiss shap38      A                                                                                                     C                          D1F P      01984010119960101        N
L6550003004prosthetic tissue shaping
L6570002003Interscapular thoracic, molded socket, endoskeletal system, including soft      Scap thorac prosth tiss shap38      A                                                                                                     C                          D1F P      01984010119960101        N
L6570003004prosthetic tissue shaping
L6580001003Preparatory, wrist disarticulation or below elbow, single wall plastic socket,  Wrist/elbow bowden cable mol38      A                                                                                                     C                          D1F P      01988010119960101        N
L6580002004friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff,
L6580003004bowden cable control, usmc or equal pylon, no cover, molded to patient model
L6582001003Preparatory, wrist disarticulation or below elbow, single wall socket, friction Wrist/elbow bowden cbl dir f38      A                                                                                                     C                          D1F P      01988010119960101        N
L6582002004wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden
L6582003004cable control, usmc or equal pylon, no cover, direct formed
L6584001003Preparatory, elbow disarticulation or above elbow, single wall plastic socket,  Elbow fair lead cable molded38      A                                                                                                     C                          D1F P      01988010119960101        N
L6584002004friction wrist, locking elbow, figure of eight harness, fair lead cable
L6584003004control, usmc or equal pylon, no cover, molded to patient model
L6586001003Preparatory, elbow disarticulation or above elbow, single wall socket, friction Elbow fair lead cable dir fo38      A                                                                                                     C                          D1F P      01988010119960101        N
L6586002004wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or
L6586003004equal pylon, no cover, direct formed
L6588001003Preparatory, shoulder disarticulation or interscapular thoracic, single wall    Shdr fair lead cable molded 38      A                                                                                                     C                          D1F P      01988010119960101        N
L6588002004plastic socket, shoulder joint, locking elbow, friction wrist, chest strap,
L6588003004fair lead cable control, usmc or equal pylon, no cover, molded to patient model
L6590001003Preparatory, shoulder disarticulation or interscapular thoracic, single wall    Shdr fair lead cable direct 38      A                                                                                                     C                          D1F P      01988010119960101        N
L6590002004socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead
L6590003004cable control, usmc or equal pylon, no cover, direct formed
L6600007003Upper extremity additions, polycentric hinge, pair                              Polycentric hinge pair      38      A                                                                                                     C                          D1F P      01982010119960101        N
L6605001003Upper extremity additions, single pivot hinge, pair                             Single pivot hinge pair     38      A                                                                                                     C                          D1F P      01982010119960101        N
L6610001003Upper extremity additions, flexible metal hinge, pair                           Flexible metal hinge pair   38      A                                                                                                     C                          D1F P      01982010119960101        N
L6611001003Addition to upper extremity prosthesis, external powered, additional switch,    Additional switch, ext power38      A                                                                                                     C                          D1F P      02007010120070101        N
L6611002004any type
L6615001003Upper extremity addition,  disconnect locking wrist unit                        Disconnect locking wrist uni38      A                                                                                                     C                          D1F P      01986010119960101        N
L6616001003Upper extremity addition, additional disconnect insert for locking wrist unit,  Disconnect insert locking wr38      A                                                                                                     C                          D1F P      01989010119960101        N
L6616002004each
L6620001003Upper extremity addition,  flexion/extension wrist unit, with or without        Flexion/extension wrist unit38      A                                                                                                     C                          D1F P      01986010120040101        N
L6620002004friction
L6621001003Upper extremity prosthesis addition, flexion/extension wrist with or without    Flex/ext wrist w/wo friction38      A                                                                                                     C                          D1F P      02006010120060101        N
L6621002004friction, for use with external powered terminal device
L6623001003Upper extremity addition,  spring assisted rotational wrist unit with latch     Spring-ass rot wrst w/ latch38      A                                                                                                     C                          D1F P      01988010119960101        N
L6623002004release
L6624001003Upper extremity addition, flexion/extension and rotation wrist unit             Flex/ext/rotation wrist unit38      A                                                                                                     C                          D1F P      02007010120070101        N
L6625001003Upper extremity addition,  rotation wrist unit with cable lock                  Rotation wrst w/ cable lock 38      A                                                                                                     C                          D1F P      01986010119960101        N
L6628001003Upper extremity addition,  quick disconnect hook adapter, otto bock or equal    Quick disconn hook adapter o38      A                                                                                                     C                          D1F P      01988010119960101        N
L6629001003Upper extremity addition,  quick disconnect lamination collar with coupling     Lamination collar w/ couplin38      A                                                                                                     C                          D1F P      01988010119960101        N
L6629002004piece, otto bock or equal
L6630001003Upper extremity addition,  stainless steel, any wrist                           Stainless steel any wrist   38      A                                                                                                     C                          D1F P      01986010119960101        N
L6632001003Upper extremity addition,  latex suspension sleeve, each                        Latex suspension sleeve each38      A                                                                                                     C                          D1F P      01988010119960101        N
L6635001003Upper extremity addition,  lift assist for elbow                                Lift assist for elbow       38      A                                                                                                     C                          D1F P      01986010119960101        N
L6637001003Upper extremity addition,  nudge control elbow lock                             Nudge control elbow lock    38      A                                                                                                     C                          D1F P      01988010119960101        N
L6638001003Upper extremity addition to prosthesis, electric locking feature, only for use  Elec lock on manual pw elbow38      A                                                                                                     C                          D1F P      02003010120030101        N
L6638002004with manually powered elbow
L6639001003Upper extremity addition, heavy duty feature, any elbow                         Heavy duty elbow feature    38      A                                                                                                     C                          D1F P      0200701012010010120091231N
L6640001003Upper extremity additions, shoulder abduction joint, pair                       Shoulder abduction joint pai38      A                                                                                                     C                          D1F P      01982010119960101        N
L6641001003Upper extremity addition,  excursion amplifier, pulley type                     Excursion amplifier pulley t38      A                                                                                                     C                          D1F P      01988010119960101        N
L6642001003Upper extremity addition,  excursion amplifier, lever type                      Excursion amplifier lever ty38      A                                                                                                     C                          D1F P      01988010119960101        N
L6645001003Upper extremity addition,  shoulder flexion-abduction joint, each               Shoulder flexion-abduction j38      A                                                                                                     C                          D1F P      01986010119960101        N
L6646001003Upper extremity addition, shoulder joint, multipositional locking, flexion,     Multipo locking shoulder jnt38      A                                                                                                     C                          D1F P      02003010120030101        N
L6646002004adjustable abduction friction control, for use with body powered or external
L6646003004powered system
L6647001003Upper extremity addition, shoulder lock mechanism, body powered actuator        Shoulder lock actuator      38      A                                                                                                     C                          D1F P      02003010120030101        N
L6648001003Upper extremity addition, shoulder lock mechanism, external powered actuator    Ext pwrd shlder lock/unlock 38      A                                                                                                     C                          D1F P      02003010120030101        N
L6650001003Upper extremity addition,  shoulder universal joint, each                       Shoulder universal joint    38      A                                                                                                     C                          D1F P      01986010119960101        N
L6655001003Upper extremity addition,  standard control cable, extra                        Standard control cable extra38      A                                                                                                     C                          D1F P      01986010119960101        N
L6660001003Upper extremity addition,  heavy duty control cable                             Heavy duty control cable    38      A                                                                                                     C                          D1F P      01986010119960101        N
L6665001003Upper extremity addition,  teflon, or equal, cable lining                       Teflon or equal cable lining38      A                                                                                                     C                          D1F P      01986010119960101        N
L6670001003Upper extremity addition,  hook to hand, cable adapter                          Hook to hand cable adapter  38      A                                                                                                     C                          D1F P      01986010119960101        N
L6672001003Upper extremity addition,  harness, chest or shoulder, saddle type              Harness chest/shlder saddle 38      A                                                                                                     C                          D1F P      01986010119960101        N
L6675001003Upper extremity addition, harness, (e. G. Figure of eight type), single cable   Harness figure of 8 sing con38      A                                                                                                     C                          D1F P      01986010120040101        N
L6675002004design
L6676001003Upper extremity addition, harness, (e. G. Figure of eight type), dual cable     Harness figure of 8 dual con38      A                                                                                                     C                          D1F P      01986010120040101        N
L6676002004design
L6677001003Upper extremity addition, harness, triple control, simultaneous operation of    UE triple control harness   38      A                                                                                                     C                          D1F P      02006010120060101        N
L6677002004terminal device and elbow
L6680001003Upper extremity addition,  test socket, wrist disarticulation or below elbow    Test sock wrist disart/bel e38      A                                                                                                     C                          D1F P      01986010119960101        N
L6682001003Upper extremity addition,  test socket, elbow disarticulation or above elbow    Test sock elbw disart/above 38      A                                                                                                     C                          D1F P      01986010119960101        N
L6684001003Upper extremity addition,  test socket, shoulder disarticulation or             Test socket shldr disart/tho38      A                                                                                                     C                          D1F P      01986010119960101        N
L6684002004interscapular thoracic
L6686001003Upper extremity addition,  suction socket                                       Suction socket              38      A                                                                                                     C                          D1F P      01988010119960101        N
L6687001003Upper extremity addition, frame type socket, below elbow or wrist               Frame typ socket bel elbow/w38      A                                                                                                     C                          D1F P      01988010119960101        N
L6687002004disarticulation
L6688001003Upper extremity addition, frame type socket, above elbow or elbow               Frame typ sock above elb/dis38      A                                                                                                     C                          D1F P      01988010119960101        N
L6688002004disarticulation
L6689001003Upper extremity addition,  frame type socket, shoulder disarticulation          Frame typ socket shoulder di38      A                                                                                                     C                          D1F P      01988010119960101        N
L6690001003Upper extremity addition,  frame type socket, interscapular-thoracic            Frame typ sock interscap-tho38      A                                                                                                     C                          D1F P      01988010119960101        N
L6691001003Upper extremity addition,  removable insert, each                               Removable insert each       38      A                                                                                                     C                          D1F P      01988010119960101        N
L6692001003Upper extremity addition, silicone gel insert or equal, each                    Silicone gel insert or equal38      A                                                                                                     C                          D1F P      01989010119960101        N
L6693001003Upper extremity addition, locking elbow, forearm counterbalance                 Lockingelbow forearm cntrbal38      A                                                                                                     C                          D1F P      01999010120000101        N
L6694001003Addition to upper extremity prosthesis, below elbow/above elbow, custom         Elbow socket ins use w/lock 38      A                                                                                                     C                          D1F P      02005010120050101        N
L6694002004fabricated from existing mold or prefabricated, socket insert, silicone gel,
L6694003004elastomeric or equal, for use with locking mechanism
L6695001003Addition to upper extremity prosthesis, below elbow/above elbow, custom         Elbow socket ins use w/o lck38      A                                                                                                     C                          D1F P      02005010120050101        N
L6695002004fabricated from existing mold or prefabricated, socket insert, silicone gel,
L6695003004elastomeric or equal, not for use with locking mechanism
L6696001003Addition to upper extremity prosthesis, below elbow/above elbow, custom         Cus elbo skt in for con/atyp38      A                                                                                                     C                          D1F P      02005010120050101        N
L6696002004fabricated socket insert for congenital or atypical traumatic amputee, silicone
L6696003004gel, elastomeric or equal, for use with or without locking mechanism, initial
L6696004004only (for other than initial, use code l6694 or l6695)
L6697001003Addition to upper extremity prosthesis, below elbow/above elbow, custom         Cus elbo skt in not con/atyp38      A                                                                                                     C                          D1F P      02005010120050101        N
L6697002004fabricated socket insert for other than congenital or atypical traumatic
L6697003004amputee, silicone gel, elastomeric or equal, for use with or without locking
L6697004004mechanism, initial only (for other than initial, use code l6694 or l6695)
L6698001003Addition to upper extremity prosthesis, below elbow/above elbow, lock           Below/above elbow lock mech 38      A                                                                                                     C                          D1F P      02005010120050101        N
L6698002004mechanism, excludes socket insert
L6703001003Terminal device, passive hand/mitt, any material, any size                      Term dev, passive hand mitt 38      A                                                                                                     C                          D1F P      02007010120070101        N
L6704001003Terminal device, sport/recreational/work attachment, any material, any size     Term dev, sport/rec/work att38      A                                                                                                     C                          D1F P      02007010120070101        N
L6706001003Terminal device, hook, mechanical, voluntary opening, any material, any size,   Term dev mech hook vol open 38      A                                                                                                     C                          D1F P      02007010120070101        N
L6706002004lined or unlined
L6707001003Terminal device, hook, mechanical, voluntary closing, any material, any size,   Term dev mech hook vol close38      A                                                                                                     C                          D1F P      02007010120070101        N
L6707002004lined or unlined
L6708001003Terminal device, hand, mechanical, voluntary opening, any material, any size    Term dev mech hand vol open 38      A                                                                                                     C                          D1F P      02007010120070101        N
L6709001003Terminal device, hand, mechanical, voluntary closing, any material, any size    Term dev mech hand vol close38      A                                                                                                     C                          D1F P      02007010120070101        N
L6711001003Terminal device, hook, mechanical, voluntary opening, any material, any size,   Ped term dev, hook, vol open38      A                                                                                                     C                          D1F P      02009010120090101        N
L6711002004lined or unlined, pediatric
L6712001003Terminal device, hook, mechanical, voluntary closing, any material, any size,   Ped term dev, hook, vol clos38      A                                                                                                     C                          D1F P      02009010120090101        N
L6712002004lined or unlined, pediatric
L6713001003Terminal device, hand, mechanical, voluntary opening, any material, any size,   Ped term dev, hand, vol open38      A                                                                                                     C                          D1F P      02009010120090101        N
L6713002004pediatric
L6714001003Terminal device, hand, mechanical, voluntary closing, any material, any size,   Ped term dev, hand, vol clos38      A                                                                                                     C                          D1F P      02009010120090101        N
L6714002004pediatric
L6715001003Terminal device, multiple articulating digit, includes motor(s), initial issue  Term device, multi art digit38      A                                                                                                     C                          D1F P      02012010120120101        N
L6715002004or replacement
L6721001003Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any   Hook/hand, hvy dty, vol open38      A                                                                                                     C                          D1F P      02009010120090101        N
L6721002004material, any size, lined or unlined
L6722001003Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any   Hook/hand, hvy dty, vol clos38      A                                                                                                     C                          D1F P      02009010120090101        N
L6722002004material, any size, lined or unlined
L6805001003Addition to terminal device, modifier wrist unit                                Term dev modifier wrist unit38      A                  2133                                                                               D                          D1F P      01985010120070101        N
L6810001003Addition to terminal device, precision pinch device                             Term dev precision pinch dev38      A                  2133                                                                               D                          D1F P      01988010120070101        N
L6880001003Electric hand, switch or myolelectric controlled, independently articulating    Elec hand ind art digits    38      A                                                                                                     C                          D1F P      02012010120120101        N
L6880002004digits, any grasp pattern or combination of grasp patterns, includes motor(s)
L6881001003Automatic grasp feature, addition to upper limb electric prosthetic terminal    Term dev auto grasp feature 38      A                                                                                                     C                          D1F P      02002010120070101        N
L6881002004device
L6882001003Microprocessor control feature, addition to upper limb prosthetic terminal      Microprocessor control uplmb38      A                  2133                                                                               D                          D1F P      02002010120020101        N
L6882002004device
L6883001003Replacement socket, below elbow/wrist disarticulation, molded to patient model, Replc sockt below e/w disa  38      A                                                                                                     C                          D1F P      02006010120060101        N
L6883002004for use with or without external power
L6884001003Replacement socket, above elbow/elbow disarticulation, molded to patient model, Replc sockt above elbow disa38      A                                                                                                     C                          D1F P      02006010120070101        N
L6884002004for use with or without external power
L6885001003Replacement socket, shoulder disarticulation/interscapular thoracic, molded to  Replc sockt shldr dis/interc38      A                                                                                                     C                          D1F P      02006010120060101        N
L6885002004patient model, for use with or without external power
L6890002003Addition to upper extremity prosthesis, glove for terminal device, any          Prefab glove for term device38      A                                                                                                     C                          D1F P      01986010120050101        N
L6890003004material, prefabricated, includes fitting and adjustment
L6895001003Addition to upper extremity prosthesis, glove for terminal device, any          Custom glove for term device38      A                                                                                                     C                          D1F P      01986010120050101        N
L6895002004material, custom fabricated
L6900002003Hand restoration (casts, shading and measurements included), partial hand, with Hand restorat thumb/1 finger38      A                                                                                                     C                          D1F P      01982010119960101        N
L6900003004glove, thumb or one finger remaining
L6905001003Hand restoration (casts, shading and measurements included), partial hand, with Hand restoration multiple fi38      A                                                                                                     C                          D1F P      01986010119960101        N
L6905002004glove, multiple fingers remaining
L6910001003Hand restoration (casts, shading and measurements included), partial hand, with Hand restoration no fingers 38      A                                                                                                     C                          D1F P      01982010119960101        N
L6910002004glove, no fingers remaining
L6915001003Hand restoration (shading, and measurements included), replacement glove for    Hand restoration replacmnt g38      A                                                                                                     C                          D1F P      01982010119960101        N
L6915002004above
L6920002003Wrist disarticulation, external power, self-suspended inner socket, removable   Wrist disarticul switch ctrl38      A                                                                                                     C                          D1F P      01988010119960101        N
L6920003004forearm shell, otto bock or equal, switch, cables, two batteries and one
L6920004004charger, switch control of terminal device
L6925001003Wrist disarticulation, external power, self-suspended inner socket, removable   Wrist disart myoelectronic c38      A                                                                                                     C                          D1F P      01988010119960101        N
L6925002004forearm shell, otto bock or equal electrodes, cables, two batteries and one
L6925003004charger, myoelectronic control of terminal device
L6930001003Below elbow, external power, self-suspended inner socket, removable forearm     Below elbow switch control  38      A                                                                                                     C                          D1F P      01988010119960101        N
L6930002004shell, otto bock or equal switch, cables, two batteries and one charger, switch
L6930003004control of terminal device
L6935001003Below elbow, external power, self-suspended inner socket, removable forearm     Below elbow myoelectronic ct38      A                                                                                                     C                          D1F P      01988010119960101        N
L6935002004shell, otto bock or equal electrodes, cables, two batteries and one charger,
L6935003004myoelectronic control of terminal device
L6940001003Elbow disarticulation, external power, molded inner socket, removable humeral   Elbow disarticulation switch38      A                                                                                                     C                          D1F P      01988010119960101        N
L6940002004shell, outside locking hinges, forearm, otto bock or equal switch, cables, two
L6940003004batteries and one charger, switch control of terminal device
L6945001003Elbow disarticulation, external power, molded inner socket, removable humeral   Elbow disart myoelectronic c38      A                                                                                                     C                          D1F P      01988010119960101        N
L6945002004shell, outside locking hinges, forearm, otto bock or equal electrodes, cables,
L6945003004two batteries and one charger, myoelectronic control of terminal device
L6950001003Above elbow, external power, molded inner socket, removable humeral shell,      Above elbow switch control  38      A                                                                                                     C                          D1F P      01988010119960101        N
L6950002004internal locking elbow, forearm, otto bock or equal switch, cables, two
L6950003004batteries and one charger, switch control of terminal device
L6955001003Above elbow, external power, molded inner socket, removable humeral shell,      Above elbow myoelectronic ct38      A                                                                                                     C                          D1F P      01988010119960101        N
L6955002004internal locking elbow, forearm, otto bock or equal electrodes, cables, two
L6955003004batteries and one charger, myoelectronic control of terminal device
L6960001003Shoulder disarticulation, external power, molded inner socket, removable        Shldr disartic switch contro38      A                                                                                                     C                          D1F P      01988010119960101        N
L6960002004shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm,
L6960003004otto bock or equal switch, cables, two batteries and one charger, switch
L6960004004control of terminal device
L6965001003Shoulder disarticulation, external power, molded inner socket, removable        Shldr disartic myoelectronic38      A                                                                                                     C                          D1F P      01988010119960101        N
L6965002004shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm,
L6965003004otto bock or equal electrodes, cables, two batteries and one charger,
L6965004004myoelectronic control of terminal device
L6970001003Interscapular-thoracic, external power, molded inner socket, removable shoulder Interscapular-thor switch ct38      A                                                                                                     C                          D1F P      01988010119960101        N
L6970002004shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock
L6970003004or equal switch, cables, two batteries and one charger, switch control of
L6970004004terminal device
L6975001003Interscapular-thoracic, external power, molded inner socket, removable shoulder Interscap-thor myoelectronic38      A                                                                                                     C                          D1F P      01988010119960101        N
L6975002004shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock
L6975003004or equal electrodes, cables, two batteries and one charger, myoelectronic
L6975004004control of terminal device
L7007001003Electric hand, switch or myoelectric controlled, adult                          Adult electric hand         38      A                                                                                                     C                          D1F P      02007010120070101        N
L7008001003Electric hand, switch or myoelectric, controlled, pediatric                     Pediatric electric hand     38      A                                                                                                     C                          D1F P      02007010120070101        N
L7009001003Electric hook, switch or myoelectric controlled, adult                          Adult electric hook         38      A                                                                                                     C                          D1F P      02007010120070101        N
L7040001003Prehensile actuator, switch controlled                                          Prehensile actuator         38      A                                                                                                     C                          D1F P      01988010120070101        N
L7045001003Electric hook, switch or myoelectric controlled, pediatric                      Pediatric electric hook     38      A                                                                                                     C                          D1F P      01988010120070101        N
L7170001003Electronic elbow, hosmer or equal, switch controlled                            Electronic elbow hosmer swit38      A                                                                                                     C                          D1F P      01988010119960101        N
L7180001003Electronic elbow, microprocessor sequential control of elbow and terminal deviceElectronic elbow sequential 38      A                                                                                                     C                          D1F P      01988010120050101        N
L7181001003Electronic elbow, microprocessor simultaneous control of elbow and terminal     Electronic elbo simultaneous38      A                                                                                                     C                          D1F P      02005010120050101        N
L7181002004device
L7185001003Electronic elbow, adolescent, variety village or equal, switch controlled       Electron elbow adolescent sw38      A                                                                                                     C                          D1F P      01988010119960101        N
L7186001003Electronic elbow, child, variety village or equal, switch controlled            Electron elbow child switch 38      A                                                                                                     C                          D1F P      01989010119960101        N
L7190001003Electronic elbow, adolescent, variety village or equal, myoelectronically       Elbow adolescent myoelectron38      A                                                                                                     C                          D1F P      01988010119960101        N
L7190002004controlled
L7191001003Electronic elbow, child, variety village or equal, myoelectronically controlled Elbow child myoelectronic ct38      A                                                                                                     C                          D1F P      01989010119960101        N
L7260001003Electronic wrist rotator, otto bock or equal                                    Electron wrist rotator otto 38      A                                                                                                     C                          D1F P      01988010119960101        N
L7261001003Electronic wrist rotator, for utah arm                                          Electron wrist rotator utah 38      A                                                                                                     C                          D1F P      01988010119960101        N
L7266001003Servo control, steeper or equal                                                 Servo control steeper or equ38      A                                                                                                     C                          D1F P      0198801012012010120111231N
L7272001003Analogue control, unb or equal                                                  Analogue control unb or equa38      A                                                                                                     C                          D1F P      0198801012012010120111231N
L7274001003Proportional control, 6-12 volt, liberty, utah or equal                         Proportional ctl 12 volt uta38      A                                                                                                     C                          D1F P      0198801012012010120111231N
L7360002003Six volt battery, each                                                          Six volt bat otto bock/eq ea38      A                                                                                                     C                          D1F P      01988010120080101        N
L7362001003Battery charger, six volt, each                                                 Battery chrgr six volt otto 38      A                                                                                                     C                          D1F P      01988010120080101        N
L7364001003Twelve volt battery, each                                                       Twelve volt battery utah/equ38      A                                                                                                     C                          D1F P      01988010120080101        N
L7366001003Battery charger, twelve volt, each                                              Battery chrgr 12 volt utah/e38      A                                                                                                     C                          D1F P      01988010120080101        N
L7367001003Lithium ion battery, replacement                                                Replacemnt lithium ionbatter38      A                                                                                                     C                          D1F P      02003010120030101        N
L7368001003Lithium ion battery charger, replacement only                                   Lithium ion battery charger 38      A                                                                                                     C                          D1F P      02003010120120101        N
L7400001003Addition to upper extremity prosthesis, below elbow/wrist disarticulation,      Add UE prost be/wd, ultlite 38      A                                                                                                     C                          D1F P      02006010120060101        N
L7400002004ultralight material (titanium, carbon fiber or equal)
L7401001003Addition to upper extremity prosthesis, above elbow disarticulation, ultralight Add UE prost a/e ultlite mat38      A                                                                                                     C                          D1F P      02006010120060101        N
L7401002004material (titanium, carbon fiber or equal)
L7402001003Addition to upper extremity prosthesis, shoulder disarticulation/interscapular  Add UE prost s/d ultlite mat38      A                                                                                                     C                          D1F P      02006010120060101        N
L7402002004thoracic, ultralight material (titanium, carbon fiber or equal)
L7403001003Addition to upper extremity prosthesis, below elbow/wrist disarticulation,      Add UE prost b/e acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        N
L7403002004acrylic material
L7404001003Addition to upper extremity prosthesis, above elbow disarticulation, acrylic    Add UE prost a/e acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        N
L7404002004material
L7405001003Addition to upper extremity prosthesis, shoulder disarticulation/interscapular  Add UE prost s/d acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        N
L7405002004thoracic, acrylic material
L7499001003Upper extremity prosthesis, not otherwise specified                             Upper extremity prosthes NOS46      A                                                                                                     C                          D1F P      01985010119980101        N
L7500002003Repair of prosthetic device, hourly rate (excludes v5335 repair of oral or      Prosthetic dvc repair hourly46      A                  2100.4  2130D   2133                                                               D                          D1F P      0198201012012010120111231N
L7500003004laryngeal prosthesis or artificial larynx)
L7510001003Repair of prosthetic device, repair or replace minor parts                      Prosthetic device repair rep46      A                  2100.4  2130D   2133                                                               D                          D1F P      01985010120030101        N
L7520001003Repair prosthetic device, labor component, per 15 minutes                       Repair prosthesis per 15 min46      A                                                                                                     C                          D1F P      01997010120000101        N
L7600001003Prosthetic donning sleeve, any material, each                                   Prosthetic donning sleeve   00      9                                          1862(1)(a)                                                 S                          D1F P      02006010120060101        N
L7900001003Male vacuum erection system                                                     Male vacuum erection system 38      A                                                                                                     C                          D1F P      01997010120030101        N
L7902001003Tension ring, for vacuum erection device, any type, replacement only, each      Tension ring, vac erect dev 38      A                                                                                                     C                          D1F P      02013010120130101        A
L8000002003Breast prosthesis, mastectomy bra, without integrated breast prosthesis form,   Mastectomy bra              38      A                  2130 A                                                                             D                          D1F P      01986010120130101        C
L8000003004any size, any type
L8001001003Breast prosthesis, mastectomy bra, with integrated breast prosthesis form,      Breast prosthesis bra & form38      A                  2130A                                                                              D                          D1F P      02002010120130101        C
L8001002004unilateral, any size, any type
L8002001003Breast prosthesis, mastectomy bra, with integrated breast prosthesis form,      Brst prsth bra & bilat form 38      A                  2130A                                                                              D                          D1F P      02002010120130101        C
L8002002004bilateral, any size, any type
L8010001003Breast prosthesis, mastectomy sleeve                                            Mastectomy sleeve           00      9                  2130 A                                                                             D                          D1F P      01986010120050401        N
L8015001003External breast prosthesis garment, with mastectomy form, post mastectomy       Ext breastprosthesis garment38      A                  2130                                                                               D                          D1F P      01999010119990101        N
L8020001003Breast prosthesis, mastectomy form                                              Mastectomy form             38      A                  2130 A                                                                             D                          D1F P      01986010119960101        N
L8030001003Breast prosthesis, silicone or equal, without integral adhesive                 Breast prosthes w/o adhesive38      A                  2130 A                                                                             D                          D1F P      01989010120100101        N
L8031001003Breast prosthesis, silicone or equal, with integral adhesive                    Breast prosthesis w adhesive38      A                  2130 A                                                                             D                          D1F P      02010010120100101        N
L8032001003Nipple prosthesis, reusable, any type, each                                     Reusable nipple prosthesis  38      A                                                                                                     C                          D1F P      02010010120100101        N
L8035001003Custom breast prosthesis, post mastectomy, molded to patient model              Custom breast prosthesis    38      A                  2130                                                                               D                          D1F P      01999010119990101        N
L8039001003Breast prosthesis, not otherwise specified                                      Breast prosthesis NOS       46      A                                                                                                     C                          D1F P      01998010119980101        N
L8040001003Nasal prosthesis, provided by a non-physician                                   Nasal prosthesis            38      A                                                                                                     C                          D1F P      02001010120010101        N
L8041001003Midfacial prosthesis, provided by a non-physician                               Midfacial prosthesis        38      A                                                                                                     C                          D1F P      02001010120010101        N
L8042001003Orbital prosthesis, provided by a non-physician                                 Orbital prosthesis          38      A                                                                                                     C                          D1F P      02001010120010101        N
L8043001003Upper facial prosthesis, provided by a non-physician                            Upper facial prosthesis     38      A                                                                                                     C                          D1F P      02001010120010101        N
L8044001003Hemi-facial prosthesis, provided by a non-physician                             Hemi-facial prosthesis      38      A                                                                                                     C                          D1F P      02001010120010101        N
L8045001003Auricular prosthesis, provided by a non-physician                               Auricular prosthesis        38      A                                                                                                     C                          D1F P      02001010120010101        N
L8046001003Partial facial prosthesis, provided by a non-physician                          Partial facial prosthesis   38      A                                                                                                     C                          D1F P      02001010120010101        N
L8047001003Nasal septal prosthesis, provided by a non-physician                            Nasal septal prosthesis     38      A                                                                                                     C                          D1F P      02001010120010101        N
L8048001003Unspecified maxillofacial prosthesis, by report, provided by a non-physician    Unspec maxillofacial prosth 46      A                                                                                                     C                          D1F P      02001010120010101        N
L8049001003Repair or modification of maxillofacial prosthesis, labor component, 15 minute  Repair maxillofacial prosth 46      A                                                                                                     C                          D1F P      02001010120010101        N
L8049002004increments, provided by a non-physician
L8300002003Truss, single with standard pad                                                 Truss single w/ standard pad38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N
L8310001003Truss, double with standard pads                                                Truss double w/ standard pad38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N
L8320001003Truss, addition to standard pad, water pad                                      Truss addition to std pad wa38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N
L8330001003Truss, addition to standard pad, scrotal pad                                    Truss add to std pad scrotal38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N
L8400002003Prosthetic sheath, below knee, each                                             Sheath below knee           38      A                  2133                                                                               D                          D1F P      01982010119960101        N
L8410001003Prosthetic sheath, above knee, each                                             Sheath above knee           38      A                  2133                                                                               D                          D1F P      01982010119960101        N
L8415001003Prosthetic sheath, upper limb, each                                             Sheath upper limb           38      A                  2133                                                                               D                          D1F P      01988010119960101        N
L8417001003Prosthetic sheath/sock, including a gel cushion layer, below knee or above      Pros sheath/sock w gel cushn38      A                                                                                                     C                          D1F P      01997010119970101        N
L8417002004knee, each
L8420001003Prosthetic sock, multiple ply, below knee, each                                 Prosthetic sock multi ply BK38      A                  2133                                                                               D                          D1F P      01982010119990101        N
L8430001003Prosthetic sock, multiple ply, above knee, each                                 Prosthetic sock multi ply AK38      A                  2133                                                                               D                          D1F P      01982010119990101        N
L8435001003Prosthetic sock, multiple  ply, upper limb, each                                Pros sock multi ply upper lm38      A                  2133                                                                               D                          D1F P      01988010120000101        N
L8440001003Prosthetic shrinker, below knee, each                                           Shrinker below knee         38      A                  2133                                                                               D                          D1F P      01982010119960101        N
L8460001003Prosthetic shrinker, above knee, each                                           Shrinker above knee         38      A                  2133                                                                               D                          D1F P      01982010119960101        N
L8465001003Prosthetic shrinker, upper limb, each                                           Shrinker upper limb         38      A                  2133                                                                               D                          D1F P      01988010119960101        N
L8470001003Prosthetic sock, single ply, fitting, below knee, each                          Pros sock single ply BK     38      A                  2133                                                                               D                          D1F P      01982010119990101        N
L8480001003Prosthetic sock, single ply, fitting, above knee, each                          Pros sock single ply AK     38      A                  2133                                                                               D                          D1F P      01982010119990101        N
L8485001003Prosthetic sock, single ply, fitting, upper limb, each                          Pros sock single ply upper l38      A                  2133                                                                               D                          D1F P      01994010119990101        N
L8499001003Unlisted procedure for miscellaneous prosthetic services                        Unlisted misc prosthetic ser46      A                                                                                                     C                          D1F P      01982010120020101        N
L8500001003Artificial larynx, any type                                                     Artificial larynx           38      A65-5              2130                                                                               D                          D1F P      01990010119960101        N
L8501001003Tracheostomy speaking valve                                                     Tracheostomy speaking valve 38      A65-16                                                                                                D                          D1F P      01990010119960101        N
L8505001003Artificial larynx replacement battery / accessory, any type                     Artificial larynx, accessory46      A                                                                                                     C                          D1F P      02002010120020101        N
L8507001003Tracheo-esophageal voice prosthesis, patient inserted, any type, each           Trach-esoph voice pros pt in38      A                                                                                                     C                          D1F P      02002010120020101        N
L8509001003Tracheo-esophageal voice prosthesis, inserted by a licensed health care         Trach-esoph voice pros md in38      A                                                                                                     C                          D1F P      02002010120020101        N
L8509002004provider, any type
L8510001003Voice amplifier                                                                 Voice amplifier             38      A65-5                                                                                                 D                          D1F P      02002010120020101        N
L8511001003Insert for indwelling tracheoesophageal prosthesis, with or without valve,      Indwelling trach insert     38      A                                                                                                     C                          D1F P      02004010120040101        N
L8511002004replacement only, each
L8512001003Gelatin capsules or equivalent, for use with tracheoesophageal voice            Gel cap for trach voice pros38      A                                                                                                     C                          D1F P      02004010120040101        N
L8512002004prosthesis, replacement only, per 10
L8513001003Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or  Trach pros cleaning device  38      A                                                                                                     C                          D1F P      02004010120040101        N
L8513002004equal, replacement only, each
L8514001003Tracheoesophageal puncture dilator, replacement only, each                      Repl trach puncture dilator 38      A                                                                                                     C                          D1F P      02004010120040101        N
L8515001003Gelatin capsule, application device for use with tracheoesophageal voice        Gel cap app device for trach37      A                                                                                                     C                          D1F P      02005010120050101        N
L8515002004prosthesis, each
L8600003003Implantable breast prosthesis, silicone or equal                                Implant breast silicone/eq  38      A35-47             2130                                                                               D                          D1F P      01992010119971001        N
L8603001003Injectable bulking agent, collagen implant, urinary tract, 2. 5 ml syringe,     Collagen imp urinary 2.5 ml 38      A65.9                                                                                                 D                          D1F P      01995010120010101        N
L8603002004includes shipping and necessary supplies
L8604001003Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant,        Dextranomer/hyaluronic acid 00      9                                                                                                     C                          D1F P      02009010120090101        N
L8604002004urinary tract, 1 ml, includes shipping and necessary supplies
L8605001003Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal   Inj bulking agent anal canal38      A                                                                                                     C                          D1F P      02013010120130101        A
L8605002004canal, 1 ml, includes shipping and necessary supplies
L8606001003Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe,       Synthetic implnt urinary 1ml38      A65.9                                                                                                 D                          D1F P      02001010120010101        N
L8606002004includes shipping and necessary supplies
L8609001003Artificial cornea                                                               Artificial cornea           38      A                                                                                                     C                          D1F P      02006010120060101        N
L8610002003Ocular implant                                                                  Ocular implant              38      A                  2130                                                                               D                          D1F P      01992010119971001        N
L8612001003Aqueous shunt                                                                   Aqueous shunt prosthesis    38      A                  2130                                                      Q0074                    D                          D1F P      01992010119971001        N
L8613001003Ossicula implant                                                                Ossicular implant           38      A                  2130                                                                               D                          D1F P      01992010119971001        N
L8614001003Cochlear device, includes all internal and external components                  Cochlear device             38      A65-14             2130                                                                               D                          D1F P      01992010120070101        N
L8615001003Headset/headpiece for use with cochlear implant device, replacement             Coch implant headset replace38      A65-14                                                                                                D                          D1F P      02005010120050101        N
L8616001003Microphone for use with cochlear implant device, replacement                    Coch implant microphone repl38      A65-14                                                                                                D                          D1F P      02005010120050101        N
L8617001003Transmitting coil for use with cochlear implant device, replacement             Coch implant trans coil repl38      A65-14                                                                                                D                          D1F P      02005010120050101        N
L8618001003Transmitter cable for use with cochlear implant device, replacement             Coch implant tran cable repl38      A65-14                                                                                                D                          D1F P      02005010120050101        N
L8619001003Cochlear implant, external speech processor and controller, integrated system,  Coch imp ext proc/contr rplc38      A65-14                                                                                                D                          D1F P      01996010120100101        N
L8619002004replacement
L8621001003Zinc air battery for use with cochlear implant device, replacement, each        Repl zinc air battery       38      A                                                                                                     C                          D1F P      02005010120050101        N
L8622001003Alkaline battery for use with cochlear implant device, any size, replacement,   Repl alkaline battery       38      A                                                                                                     C                          D1F P      02005010120050101        N
L8622002004each
L8623001003Lithium ion battery for use with cochlear implant device speech processor,      Lith ion batt CID,non-earlvl38      A                                                                                                     C                          D1F P      02006010120060101        N
L8623002004other than ear level, replacement, each
L8624001003Lithium ion battery for use with cochlear implant device speech processor, ear  Lith ion batt CID, ear level38      A                                                                                                     C                          D1F P      02006010120060101        N
L8624002004level, replacement, each
L8627001003Cochlear implant, external speech processor, component, replacement             CID ext speech process repl 38      A65-14                                                                                                D                          D1F P      02010010120100101        N
L8628001003Cochlear implant, external controller component, replacement                    CID ext controller repl     38      A65-14                                                                                                D                          D1F P      02010010120100101        N
L8629001003Transmitting coil and cable, integrated, for use with cochlear implant device,  CID transmit coil and cable 38      A65-14                                                                                                D                          D1F P      02010010120100101        N
L8629002004replacement
L8630001003Metacarpophalangeal joint implant                                               Metacarpophalangeal implant 38      A                  2130                                                                               D                          D1F P      01992010119971001        N
L8631001003Metacarpal phalangeal joint replacement, two or more pieces, metal (e. G. ,     MCP joint repl 2 pc or more 38      A                  2130                                                                               D                          D1F P      02004010120040101        N
L8631002004stainless steel or cobalt chrome), ceramic-like material (e. G. , pyrocarbon),
L8631003004for surgical implantation (all sizes, includes entire system)
L8641001003Metatarsal joint implant                                                        Metatarsal joint implant    38      A                  2130                                                                               D                          D1F P      01992010119971001        N
L8642001003Hallux implant                                                                  Hallux implant              38      A                  2130                                                      Q0073                    D                          D1F P      01992010119971001        N
L8658001003Interphalangeal joint spacer, silicone or equal, each                           Interphalangeal joint spacer38      A                  2130                                                                               D                          D1F P      01992010120040101        N
L8659001003Interphalangeal finger joint replacement, 2 or more pieces, metal (e. G. ,      Interphalangeal joint repl  38      A                  2130                                                                               D                          D1F P      02004010120040101        N
L8659002004stainless steel or cobalt chrome), ceramic-like material (e. G. , pyrocarbon)
L8659003004for surgical implantation, any size
L8670002003Vascular graft material, synthetic, implant                                     Vascular graft, synthetic   38      A                  2130                                                                               D                          D1F P      01992010119971001        N
L8680001003Implantable neurostimulator electrode, each                                     Implt neurostim elctr each  00      9                                                                                                     I                          D1F P      02006010120130101        F
L8681001003Patient programmer (external) for use with implantable programmable             Pt prgrm for implt neurostim38      A65-8                                                                                                 D                          D1F P      02006010120090101        N
L8681002004neurostimulator pulse generator, replacement only
L8682001003Implantable neurostimulator radiofrequency receiver                             Implt neurostim radiofq rec 00      9                                                                                                     I                          D1F P      02006010120130101        F
L8683001003Radiofrequency transmitter (external) for use with implantable neurostimulator  Radiofq trsmtr for implt neu00      9                                                                                                     I                          D1F P      02006010120130101        F
L8683002004radiofrequency receiver
L8684001003Radiofrequency transmitter (external) for use with implantable sacral root      Radiof trsmtr implt scrl neu00      9                                                                                                     I                          D1F P      02006010120130101        F
L8684002004neurostimulator receiver for bowel and bladder management, replacement
L8685001003Implantable neurostimulator pulse generator, single array, rechargeable,        Implt nrostm pls gen sng rec00      9                                                                                                     I                          D1F P      02006010120130101        F
L8685002004includes extension
L8686001003Implantable neurostimulator pulse generator, single array, non-rechargeable,    Implt nrostm pls gen sng non00      9                                                                                                     I                          D1F P      02006010120130101        F
L8686002004includes extension
L8687001003Implantable neurostimulator pulse generator, dual array, rechargeable, includes Implt nrostm pls gen dua rec00      9                                                                                                     I                          D1F P      02006010120130101        F
L8687002004extension
L8688001003Implantable neurostimulator pulse generator, dual array, non-rechargeable,      Implt nrostm pls gen dua non00      9                                                                                                     I                          D1F P      02006010120130101        F
L8688002004includes extension
L8689001003External recharging system for battery (internal) for use with implantable      External recharg sys intern 38      A65-8                                                                                                 D                          D1F P      02006010120090101        N
L8689002004neurostimulator, replacement only
L8690002003Auditory osseointegrated device, includes all internal and external components  Aud osseo dev, int/ext comp 38      A                                                                                                     C                          D1F P      02007010120070101        N
L8691001003Auditory osseointegrated device, external sound processor, replacement          Osseointegrated snd proc rpl38      A                                                                                                     C                          D1F P      02007010120100101        N
L8692001003Auditory osseointegrated device, external sound processor, used without         Non-osseointegrated snd proc00      9                                          1862(a)(7)                                                 S                          D1F P      02010010120100101        N
L8692002004osseointegration, body worn, includes headband or other means of external
L8692003004attachment
L8693001003Auditory osseointegrated device abutment, any length, replacement only          Aud osseo dev, abutment     38      A                                                                                                     C                          D1F P      02011010120110101        N
L8695001003External recharging system for battery (external) for use with implantable      External recharg sys extern 38      A65-8                                                                                                 D                          D1F P      02007010120090101        N
L8695002004neurostimulator, replacement only
L8699001003Prosthetic implant, not otherwise specified                                     Prosthetic implant NOS      46      A                                                                                                     C                          D1F P      01998010119980101        N
L9900001003Orthotic and prosthetic supply, accessory, and/or service component of another  O&P supply/accessory/service46      A                                                                                                     C                          D1F P      02000010120000101        N
L9900002004hcpcs "l" code
M0064001003Brief office visit for the sole purpose of monitoring or changing drug          Visit for drug monitoring   11      A                  2476.3                                                                             D                          M5B 1      01992010119960101        N
M0064002004prescriptions used in the treatment of mental psychoneurotic and personality
M0064003004disorders
M0075001003Cellular therapy                                                                Cellular therapy            00      935-5                                                                                                 M                          Y2  1      01986010119960101        N
M0076001003Prolotherapy                                                                    Prolotherapy                00      935-13                                                                                                M                          Y2  1      01986010119960101        N
M0100001003Intragastric hypothermia using gastric freezing                                 Intragastric hypothermia    00      935-65                                                                                                M                          P1G 1      01986010120040101        N
M0300002003Iv chelation therapy (chemical endarterectomy)                                  IV chelationtherapy         00      935-64                                                                                                M                          Y2  1      01986010119960101        N
M0301001003Fabric wrapping of abdominal aneurysm                                           Fabric wrapping of aneurysm 00      935-34                                                                                                M                          P1G 2      01986010120040101        N
P2028003003Cephalin floculation, blood                                                     Cephalin floculation test   57      A50-34                                                                                                D                          T1H 5      01986010119900101        N
P2029001003Congo red, blood                                                                Congo red blood test        57      A50-34                                                                                                D                          T1H 5      01986010119900101        N
P2031001003Hair analysis (excluding arsenic)                                               Hair analysis               00      950-24                                                                                                M                          T1H 5      01986010119890101        N
P2033001003Thymol turbidity, blood                                                         Blood thymol turbidity      57      A50-34                                                                                                D                          T1H 5      01986010119900101        N
P2038001003Mucoprotein, blood (seromucoid) (medical necessity procedure)                   Blood mucoprotein           21      A50-34                                                                                                D                          T1H 5      01986010119930101        N
P3000002003Screening papanicolaou smear, cervical or vaginal, up to three smears, by       Screen pap by tech w md supv21      A50-20                                               630                                              D                      0045T1H 5      01992010119950101        N
P3000003004technician under physician supervision
P3001001003Screening papanicolaou smear, cervical or vaginal, up to three smears,          Screening pap smear by phys 1121    C50-20                                               630                                              D                      0045T1G 5      01992010120020101        N
P3001002004requiring interpretation by physician
P7001002003Culture, bacterial, urine; quantitative, sensitivity study                      Culture bacterial urine     00      9                                                    110                     CPT                      I                          T1H 5      01986010119960101        N
P9010001003Blood (whole), for transfusion, per unit                                        Whole blood for transfusion 52      A                  2455A                                                                              D                          T1H 0      01987010119870101        N
P9011001003Blood, split unit                                                               Blood split unit            52      A                  2455A                                                                              D                          T1H 0      01987010120070101        N
P9012001003Cryoprecipitate, each unit                                                      Cryoprecipitate each unit   52      A                  2455 B                                                                             D                          T1H 9      01987010120010101        N
P9016001003Red blood cells, leukocytes reduced, each unit                                  RBC leukocytes reduced      52      A                  2455 B                                                                             D                          T1H 0      01987010120010101        N
P9017001003Fresh frozen plasma (single donor), frozen within 8 hours of collection, each   Plasma 1 donor frz w/in 8 hr52      A                  2455 B                                                                             D                          T1H 9      01987010120040101        N
P9017002004unit
P9019001003Platelets, each unit                                                            Platelets, each unit        52      A                  2455 B                                                                             D                          T1H 9      01987010120010101        N
P9020001003Platelet rich plasma, each unit                                                 Plaelet rich plasma unit    52      A                  2455 B                                                                             D                          T1H 9      01987010120010101        N
P9021001003Red blood cells, each unit                                                      Red blood cells unit        52      A                  2455A                                                                              D                          T1H 0      01987010120010101        N
P9022001003Red blood cells, washed, each unit                                              Washed red blood cells unit 52      A                  2455A                                                                              D                          T1H 0      01987010119870101        N
P9023001003Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit     Frozen plasma, pooled, sd   52      A                  2455 B                                                                             D                          T1H 9      02000010120010101        N
P9031001003Platelets, leukocytes reduced, each unit                                        Platelets leukocytes reduced52      A                  2455                                                                               D                          T1H 9      02001010120010101        N
P9032001003Platelets, irradiated, each unit                                                Platelets, irradiated       52      A                  2455                                                                               D                          T1H 9      02001010120010101        N
P9033001003Platelets, leukocytes reduced, irradiated, each unit                            Platelets leukoreduced irrad52      A                  2455                                                                               D                          T1H 9      02001010120010101        N
P9034001003Platelets, pheresis, each unit                                                  Platelets, pheresis         52      A                  2455                                                                               D                          T1H 9      02001010120010101        N
P9035001003Platelets, pheresis, leukocytes reduced, each unit                              Platelet pheres leukoreduced52      A                  2455                                                                               D                          T1H 9      02001010120010101        N
P9036001003Platelets, pheresis, irradiated, each unit                                      Platelet pheresis irradiated52      A                  2455                                                                               D                          T1H 9      02001010120010101        N
P9037001003Platelets, pheresis, leukocytes reduced, irradiated, each unit                  Plate pheres leukoredu irrad52      A                  2455                                                                               D                          T1H 9      02001010120010101        N
P9038001003Red blood cells, irradiated, each unit                                          RBC irradiated              52      A                  2455                                                                               D                          T1H 0      02001010120010101        N
P9039001003Red blood cells, deglycerolized, each unit                                      RBC deglycerolized          52      A                  2455                                                                               D                          T1H 0      02001010120010101        N
P9040001003Red blood cells, leukocytes reduced, irradiated, each unit                      RBC leukoreduced irradiated 52      A                  2455                                                                               D                          T1H 0      02001010120010101        N
P9041001003Infusion, albumin (human), 5%, 50 ml                                            Albumin (human),5%, 50ml    52      A                                                                                                     CYY20080101                T1H 9      02001010120010101        N
P9043001003Infusion, plasma protein fraction (human), 5%, 50 ml                            Plasma protein fract,5%,50ml52      A                  2455B                                                                              D                          T1H 9      02001010120010101        N
P9044001003Plasma, cryoprecipitate reduced, each unit                                      Cryoprecipitatereducedplasma52      A                  2455.B                                                                             D                          T1H 9      02001010120010101        N
P9045001003Infusion, albumin (human), 5%, 250 ml                                           Albumin (human), 5%, 250 ml 52      A                                                                                                     CYY20080101                Y2  9      02002010120020101        N
P9046001003Infusion, albumin (human), 25%, 20 ml                                           Albumin (human), 25%, 20 ml 52      A                                                                                                     CYY20080101                Y2  9      02002010120020101        N
P9047001003Infusion, albumin (human), 25%, 50 ml                                           Albumin (human), 25%, 50ml  52      A                                                                                                     CYY20080101                Y2  9      02002010120020101        N
P9048001003Infusion, plasma protein fraction (human), 5%, 250ml                            Plasmaprotein fract,5%,250ml52      A                                                                                                     C                          Y2  9      02002010120020101        N
P9050001003Granulocytes, pheresis, each unit                                               Granulocytes, pheresis unit 52      A                                                                                                     C                          Z2  9      02002010120020101        N
P9051001003Whole blood or red blood cells, leukocytes reduced, cmv-negative, each unit     Blood, l/r, cmv-neg         52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N
P9052001003Platelets, hla-matched leukocytes reduced, apheresis/pheresis, each unit        Platelets, hla-m, l/r, unit 52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N
P9053001003Platelets, pheresis, leukocytes reduced, cmv-negative, irradiated, each unit    Plt, pher, l/r cmv-neg, irr 52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N
P9054001003Whole blood or red blood cells, leukocytes reduced, frozen, deglycerol, washed, Blood, l/r, froz/degly/wash 52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N
P9054002004each unit
P9055001003Platelets, leukocytes reduced, cmv-negative, apheresis/pheresis, each unit      Plt, aph/pher, l/r, cmv-neg 52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N
P9056001003Whole blood, leukocytes reduced, irradiated, each unit                          Blood, l/r, irradiated      52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N
P9057001003Red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated,  RBC, frz/deg/wsh, l/r, irrad52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N
P9057002004each unit
P9058001003Red blood cells, leukocytes reduced, cmv-negative, irradiated, each unit        RBC, l/r, cmv-neg, irrad    52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N
P9059001003Fresh frozen plasma between 8-24 hours of collection, each unit                 Plasma, frz between 8-24hour52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N
P9060001003Fresh frozen plasma, donor retested, each unit                                  Fr frz plasma donor retested52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N
P9603002003Travel allowance one way in connection with medically necessary laboratory      One-way allow prorated miles22      A                  51141K                                                                             D                      0039Y2  5      01987010119920101        N
P9603003004specimen collection drawn from home bound or nursing home bound patient;
P9603004004prorated miles actually travelled
P9604001003Travel allowance one way in connection with medically necessary laboratory      One-way allow prorated trip 22      A                  51141K                                                                             D                      0039Y2  5      01987010119920101        N
P9604002004specimen collection drawn from home bound or nursing home bound patient;
P9604003004prorated trip charge.
P9612001003Catheterization for collection of specimen, single patient, all places of       Catheterize for urine spec  57      A                  5114.1D                                                                            D                          T1H 5      01999010119990101        N
P9612002004service
P9615001003Catheterization for collection of specimen (s) (multiple patients)              Urine specimen collect mult 57      A                  51141D                                                                             D                      0040T1H 5      01985010119920101        N
Q0035001003Cardiokymography                                                                Cardiokymography            11      A50-50                                                                                                D                          T2D 5      01989010119910101        N
Q0081001003Infusion therapy, using other than chemotherapeutic drugs, per visit            Infusion ther other than che00      960-14                                                                                                D                      0041P6C 1      01992010119960101        N
Q0083001003Chemotherapy administration by other than infusion technique only (eg           Chemo by other than infusion00      9                                                                                                     C                      0041O1D 1      01992010119960101        N
Q0083002004subcutaneous, intramuscular, push), per visit
Q0084001003Chemotherapy administration by infusion technique only, per visit               Chemotherapy by infusion    00      960-14                                                                                                D                      0041O1D 1      01992010119960101        N
Q0085001003Chemotherapy administration by both infusion technique and other techique(s)    Chemo by both infusion and o00      9                                                                                                     C                      0041O1D 1      01992010119960101        N
Q0085002004(eg subcutaneous, intramuscular, push), per visit
Q0091001003Screening papanicolaou smear; obtaining, preparing and conveyance of cervical   Obtaining screen pap smear  11      A50-20                                                                                                D                          P6C 1      01992010119960701        N
Q0091002004or vaginal smear to laboratory
Q0092001003Set-up portable x-ray equipment                                                 Set up port xray equipment  11      A                  2070.4                                                                             D                          I1F 4      01993010119960101        N
Q0111001003Wet mounts, including preparations of vaginal, cervical or skin specimens       Wet mounts/ w preparations  21      A                                                    110120130                                        C                          T1H 5      01994010119940101        N
Q0112001003All potassium hydroxide (koh) preparations                                      Potassium hydroxide preps   21      A                                                    120                                              C                          T1H 5      01994010119940101        N
Q0113001003Pinworm examinations                                                            Pinworm examinations        21      A                                                    130                                              C                          T1H 5      01994010119940101        N
Q0114001003Fern test                                                                       Fern test                   21      A                                                    310                                              C                          T1H 5      01994010119940101        N
Q0115001003Post-coital direct, qualitative examinations of vaginal or cervical mucous      Post-coital mucous exam     21      A                                                    400                                              C                          T1H 5      01994010119940101        N
Q0138001003Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd Ferumoxytol, non-esrd       51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N
Q0138002004use)
Q0139001003Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd Ferumoxytol, esrd use       51      A                                                                                                     C                          O1E 1P     02010010120100101        N
Q0139002004on dialysis)
Q0144001003Azithromycin dihydrate, oral, capsules/powder, 1 gram                           Azithromycin dihydrate, oral00      9                                                                                                     M                      0054O1E 1      01996070120020701        N
Q0162001003Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a     Ondansetron oral            51      A                                          4557                                                       D                          O1D 1P     02012010120120101        N
Q0162002004complete therapeutic substitute for an iv anti-emetic at the time of
Q0162003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0163001003Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription           Diphenhydramine HCl 50mg    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0163002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0163003004at time of chemotherapy treatment not to exceed a 48 hour dosage regimen
Q0164001003Prochlorperazine maleate, 5  mg, oral, fda approved prescription anti-emetic,   Prochlorperazine maleate 5mg51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0164002004for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0164003004of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0165001003Prochlorperazine maleate, 10  mg, oral, fda approved prescription anti-emetic,  Prochlorperazine maleate10mg51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0165002004for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0165003004of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0166001003Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic,   Granisetron hcl 1 mg oral   51      A                                          4557                                                       D                          O1D 1      01998040120090101        N
Q0166002004for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0166003004of chemotherapy treatment, not to exceed a 24 hour dosage regimen
Q0167001003Dronabinol, 2. 5 mg, oral, fda approved prescription anti-emetic, for use as a  Dronabinol 2.5mg oral       51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0167002004complete therapeutic substitute for an iv anti-emetic at the time of
Q0167003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0168001003Dronabinol, 5 mg, oral, fda approved prescription anti-emetic, for use as a     Dronabinol 5mg oral         51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0168002004complete therapeutic substitute for an iv anti-emetic at the time of
Q0168003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0169001003Promethazine hydrochloride, 12. 5 mg, oral, fda approved prescription           Promethazine HCl 12.5mg oral51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0169002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0169003004at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0170001003Promethazine hydrochloride, 25  mg, oral, fda approved prescription             Promethazine HCl 25 mg oral 51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0170002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0170003004at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0171001003Chlorpromazine hydrochloride, 10  mg, oral, fda approved prescription           Chlorpromazine HCl 10mg oral51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0171002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0171003004at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0172001003Chlorpromazine hydrochloride, 25 mg, oral, fda approved prescription            Chlorpromazine HCl 25mg oral51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0172002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0172003004at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0173001003Trimethobenzamide hydrochloride, 250 mg, oral, fda approved prescription        Trimethobenzamide HCl 250mg 51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0173002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic
Q0173003004at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0174001003Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic,   Thiethylperazine maleate10mg51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0174002004for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0174003004of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0175001003Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a   Perphenazine 4mg oral       51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0175002004complete therapeutic substitute for an iv anti-emetic at the time of
Q0175003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0176001003Perphenazine, 8mg, oral, fda approved prescription anti-emetic, for use as a    Perphenazine 8mg oral       51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0176002004complete therapeutic substitute for an iv anti-emetic at the time of
Q0176003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0177001003Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for    Hydroxyzine pamoate 25mg    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0177002004use as a complete therapeutic substitute for an iv anti-emetic at the time of
Q0177003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0178001003Hydroxyzine pamoate, 50 mg, oral, fda approved prescription anti-emetic, for    Hydroxyzine pamoate 50mg    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0178002004use as a complete therapeutic substitute for an iv anti-emetic at the time of
Q0178003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0179001003Ondansetron hydrochloride 8  mg, oral, fda approved prescription anti-emetic,   Ondansetron hcl 8 mg oral   51      A                                          4557                                                       D                          O1D 1      0199804012012010120111231N
Q0179002004for use as a complete therapeutic substitute for an iv anti-emetic at the time
Q0179003004of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0180001003Dolasetron mesylate, 100  mg, oral, fda approved prescription anti-emetic, for  Dolasetron mesylate oral    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0180002004use as a complete therapeutic substitute for an iv anti-emetic at the time of
Q0180003004chemotherapy treatment, not to exceed a 24 hour dosage regimen
Q0181001003Unspecified oral dosage form, fda approved prescription anti-emetic, for use as Unspecified oral anti-emetic51      A                                          4557                                                       D                          O1D 1      01998040119980401        N
Q0181002004a complete therapeutic substitute for a iv anti-emetic at the time of
Q0181003004chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q0478001003Power adapter for use with electric or electric/pneumatic ventricular assist    Power adapter, combo vad    38      A                                                                                                     D                      0178D1F P      02011010120130101        F
Q0478002004device, vehicle type
Q0479001003Power module for use with electric or electric/pneumatic ventricular assist     Power module combo vad, rep 38      A                                                                                                     D                      0178D1F P      02011010120130101        F
Q0479002004device, replacement only
Q0480001003Driver for use with pneumatic ventricular assist device, replacement only       Driver pneumatic vad, rep   38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0481001003Microprocessor control unit for use with electric ventricular assist device,    Microprcsr cu elec vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0481002004replacement only
Q0482001003Microprocessor control unit for use with electric/pneumatic combination         Microprcsr cu combo vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0482002004ventricular assist device, replacement only
Q0483001003Monitor/display module for use with electric ventricular assist device,         Monitor elec vad, rep       38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0483002004replacement only
Q0484001003Monitor/display module for use with electric or electric/pneumatic ventricular  Monitor elec or comb vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0484002004assist device, replacement only
Q0485001003Monitor control cable for use with electric ventricular assist device,          Monitor cable elec vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0485002004replacement only
Q0486001003Monitor control cable for use with electric/pneumatic ventricular assist        Mon cable elec/pneum vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0486002004device, replacement only
Q0487001003Leads (pneumatic/electrical) for use with any type electric/pneumatic           Leads any type vad, rep only38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0487002004ventricular assist device, replacement only
Q0488001003Power pack base for use with electric ventricular assist device, replacement    Pwr pack base elec vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0488002004only
Q0489001003Power pack base for use with electric/pneumatic ventricular assist device,      Pwr pck base combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0489002004replacement only
Q0490001003Emergency power source for use with electric ventricular assist device,         Emr pwr source elec vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0490002004replacement only
Q0491001003Emergency power source for use with electric/pneumatic ventricular assist       Emr pwr source combo vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0491002004device, replacement only
Q0492001003Emergency power supply cable for use with electric ventricular assist device,   Emr pwr cbl elec vad, rep   38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0492002004replacement only
Q0493001003Emergency power supply cable for use with electric/pneumatic ventricular assist Emr pwr cbl combo vad, rep  38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0493002004device, replacement only
Q0494001003Emergency hand pump for use with electric or electric/pneumatic ventricular     Emr hd pmp elec/combo, rep  38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0494002004assist device, replacement only
Q0495001003Battery/power pack charger for use with electric or electric/pneumatic          Charger elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0495002004ventricular assist device, replacement only
Q0496001003Battery, other than lithium-ion, for use with electric or electric/pneumatic    Battery elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0496002004ventricular assist device, replacement only
Q0497001003Battery clips for use with electric or electric/pneumatic ventricular assist    Bat clps elec/comb vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0497002004device, replacement only
Q0498001003Holster for use with electric or electric/pneumatic ventricular assist device,  Holster elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0498002004replacement only
Q0499001003Belt/vest/bag for use to carry external peripheral components of any type       Belt/vest elec/combo vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0499002004ventricular assist device, replacement only
Q0500001003Filters for use with electric or electric/pneumatic ventricular assist device,  Filters elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0500002004replacement only
Q0501001003Shower cover for use with electric or electric/pneumatic ventricular assist     Shwr cov elec/combo vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0501002004device, replacement only
Q0502001003Mobility cart for pneumatic ventricular assist device, replacement only         Mobility cart pneum vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0503001003Battery for pneumatic ventricular assist device, replacement only, each         Battery pneum vad replacemnt38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0504001003Power adapter for pneumatic ventricular assist device, replacement only,        Pwr adpt pneum vad, rep veh 38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0504002004vehicle type
Q0505001003Miscellaneous supply or accessory for use with ventricular assist device        Miscl supply/accessory vad  38      A                                                                                                     D                      0178D1F P      02005100120130101        F
Q0506001003Battery, lithium-ion, for use with electric or electric/pneumatic ventricular   Lith-ion batt elec/pneum VAD38      A                                                                                                     D                      0178D1F P      02010010120130101        F
Q0506002004assist device, replacement only
Q0510001003Pharmacy supply fee for initial immunosuppressive drug(s), first month          Dispens fee immunosupressive46      A                                                                                                     D                      0129O1E 9      02006010120060101        N
Q0510002004following transplant
Q0511001003Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive Sup fee antiem,antica,immuno46      A                                                                                                     D                      0129O1E 9      02006010120060101        N
Q0511002004drug(s); for the first prescription in a 30-day period
Q0512001003Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive Px sup fee anti-can sub pres46      A                                                                                                     D                      0129O1E 9      02006010120090101        N
Q0512002004drug(s); for a subsequent prescription in a 30-day period
Q0513001003Pharmacy dispensing fee for inhalation drug(s); per 30 days                     Disp fee inhal drugs/30 days46      A                                                                                                     D                      0129O1E 9      02006010120060101        N
Q0514001003Pharmacy dispensing fee for inhalation drug(s); per 90 days                     Disp fee inhal drugs/90 days46      A                                                                                                     D                      0129O1E 9      02006010120060101        N
Q0515001003Injection, sermorelin acetate, 1 microgram                                      Sermorelin acetate injection51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120060101        N
Q1003001003New technology intraocular lens category 3 (reduced spherical aberration)       Ntiol category 3            57      A                                                                                                     C                          D1F F      0199907012011040120110331N
Q1004001003New technology intraocular lens category 4 as defined in federal register noticeNtiol category 4            57      A                                                                                                     D                      0086D1F F      01999070120031001        N
Q1005001003New technology intraocular lens category 5 as defined in federal register noticeNtiol category 5            57      A                                                                                                     D                      0086D1F F      01999070120031001        N
Q2004001003Irrigation solution for treatment of bladder calculi, for example renacidin,    Bladder calculi irrig sol   51      A                  2049                    1861S2B                                                    D                          O1E 1P     02000070120070101        N
Q2004002004per 500 ml
Q2009001003Injection, fosphenytoin, 50 mg phenytoin equivalent                             Fosphenytoin inj PE         51      A                  2049                    1861S2B                                                    D                          O1E 1P     02000070120100101        N
Q2017001003Injection, teniposide, 50 mg                                                    Teniposide, 50 mg           51      A                  2049                    1861S2B                                                    DYY20080101                O1D 1P     02000070120070101        N
Q2023001003Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i. U. Xyntha, inj                 51      A                                                                            J7185                    C                          O1E 1P     0200907012010010120091231N
Q2024001003Injection, bevacizumab, 0. 25 mg                                                Bevacizumab injection       51      A                                                                                                     C                          O1E 1P     0200910012010010120091231N
Q2025001003Fludarabine phosphate, oral, 1 mg                                               Oral fludarabine phosphate  51      A                                                                            J8562                    C                          O1D 9      0201007012011010120101231N
Q2026001003Injection, radiesse, 0. 1 ml                                                    Radiesse injection          51      A                                                                                                     D                      0166O1E 9      02010070120100701        N
Q2027001003Injection, sculptra, 0. 1 ml                                                    Sculptra injection          51      A                                                                                                     D                      0166O1E 9      02010070120100701        N
Q2034001003Influenza virus vaccine, split virus, for intramuscular use (agriflu)           Agriflu vaccine             54      A                  2049.4                                                                             DYY20120701                O1G V      02012070120120701        A
Q2035001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Afluria vacc, 3 yrs & >, im 54      A                  2049.4                                                                             DYY20130101                O1G V      02011010120110101        N
Q2035002004of age and older, for intramuscular use (afluria)
Q2036001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Flulaval vacc, 3 yrs & >, im54      A                  2049.4                                                                             DYY20130101                O1G V      02011010120110101        N
Q2036002004of age and older, for intramuscular use (flulaval)
Q2037001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Fluvirin vacc, 3 yrs & >, im54      A                  2049.4                                                                             DYY20130101                O1G V      02011010120110101        N
Q2037002004of age and older, for intramuscular use (fluvirin)
Q2038001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Fluzone vacc, 3 yrs & >, im 54      A                  2049.4                                                                             DYY20101001                O1G V      02011010120110101        N
Q2038002004of age and older, for intramuscular use (fluzone)
Q2039001003Influenza virus vaccine, split virus, when administered to individuals 3 years  NOS flu vacc, 3 yrs & >, im 54      A                  2049.4                                                                             DYY20130101                O1G V      02011010120110101        N
Q2039002004of age and older, for intramuscular use (not otherwise specified)
Q2040001003Injection, incobotulinumtoxin a, 1 unit                                         Incobotulinumtoxin A        51      A                                                                            J0588                    C                          O1E 1P     0201104012012010120111231N
Q2041001003Injection, von willebrand factor complex (human), wilate, 1 i. U. Vwf:rco       Wilate injection            51      A                  2049                                                      J7183                    D                          O1E 19     0201107012012010120111231N
Q2042001003Injection, hydroxyprogesterone caproate, 1 mg                                   Hydroxyprogesterone caproate51      A                                                                            J1725                    C                          O1E 19     0201107012012010120111231N
Q2043001003Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with       Sipuleucel-T auto CD54+     53      A                                                                                                     DYY20110701            0175P1G 1      02011070120110701        N
Q2043002004pap-gm-csf, including leukapheresis and all other preparatory procedures, per
Q2043003004infusion
Q2044001003Injection, belimumab, 10 mg                                                     Belimumab injection         51      A                                                                            J0490                    C                          O1E 19     0201107012012010120111231N
Q2045001003Injection, human fibrinogen concentrate, 1 mg                                   Human fibrinogen conc inj   51      A                                                                            J7178                    C                          O1E 1P     0201207012013010120121231D
Q2046001003Injection, aflibercept, 1 mg                                                    Aflibercept injection       51      A                                                                            J0178                    C                          O1E 1P     0201207012013010120121231D
Q2047001003Injection, peginesatide, 0. 1 mg (for esrd on dialysis)                         Peginesatide injection      51      A                                                                            J0890                    C                          O1E 1P     0201207012013010120121231D
Q2048001003Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg                   Doxil injection             51      A                                                                            J9002                    C                          O1D P      0201207012013010120121231D
Q2049001003Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg        Imported lipodox inj        51      A                                                                                                     CYY20120701                O1D P      02012070120120701        A
Q3001001003Radioelements for brachytherapy, any type, each                                 Brachytherapy Radioelements 57      A                  15022                                                                              D                          P7A 1      02000070120050101        N
Q3014001003Telehealth originating site facility fee                                        Telehealth facility fee     53      A                                                                                                     C                          Y2  9      02001100120011001        N
Q3025001003Injection, interferon beta-1a, 11 mcg for intramuscular use                     IM inj interferon beta 1-a  51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120030101        N
Q3026001003Injection, interferon beta-1a, 11 mcg for subcutaneous use                      Subc inj interferon beta-1a 00      9                                                                                                     I                          O1E 1P     02003010120030101        N
Q3031001003Collagen skin test                                                              Collagen skin test          11      A65-9                                                                                                 D                          D1A 5      02003040120041001        N
Q4001001003Casting supplies, body cast adult, with or without head, plaster                Cast sup body cast plaster  52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4002001003Cast supplies, body cast adult, with or without head, fiberglass                Cast sup body cast fiberglas52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4003001003Cast supplies, shoulder cast, adult (11 years +), plaster                       Cast sup shoulder cast plstr52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4004001003Cast supplies, shoulder cast, adult (11 years +), fiberglass                    Cast sup shoulder cast fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4005001003Cast supplies, long arm cast, adult (11 years +), plaster                       Cast sup long arm adult plst52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4006001003Cast supplies, long arm cast, adult (11 years +), fiberglass                    Cast sup long arm adult fbrg52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4007001003Cast supplies, long arm cast, pediatric (0-10 years), plaster                   Cast sup long arm ped plster52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4008001003Cast supplies, long arm cast, pediatric (0-10 years), fiberglass                Cast sup long arm ped fbrgls52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4009001003Cast supplies, short arm cast, adult (11 years +), plaster                      Cast sup sht arm adult plstr52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4010001003Cast supplies, short arm cast, adult (11 years +), fiberglass                   Cast sup sht arm adult fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4011001003Cast supplies, short arm cast, pediatric (0-10 years), plaster                  Cast sup sht arm ped plaster52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4012001003Cast supplies, short arm cast, pediatric (0-10 years), fiberglass               Cast sup sht arm ped fbrglas52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4013001003Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years Cast sup gauntlet plaster   52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4013002004+), plaster
Q4014001003Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years Cast sup gauntlet fiberglass52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4014002004+), fiberglass
Q4015001003Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 Cast sup gauntlet ped plster52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4015002004years), plaster
Q4016001003Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 Cast sup gauntlet ped fbrgls52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4016002004years), fiberglass
Q4017001003Cast supplies, long arm splint, adult (11 years +), plaster                     Cast sup lng arm splint plst52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4018001003Cast supplies, long arm splint, adult (11 years +), fiberglass                  Cast sup lng arm splint fbrg52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4019001003Cast supplies, long arm splint, pediatric (0-10 years), plaster                 Cast sup lng arm splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4020001003Cast supplies, long arm splint, pediatric (0-10 years), fiberglass              Cast sup lng arm splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4021001003Cast supplies, short arm splint, adult (11 years +), plaster                    Cast sup sht arm splint plst52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4022001003Cast supplies, short arm splint, adult (11 years +), fiberglass                 Cast sup sht arm splint fbrg52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4023001003Cast supplies, short arm splint, pediatric (0-10 years), plaster                Cast sup sht arm splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4024001003Cast supplies, short arm splint, pediatric (0-10 years), fiberglass             Cast sup sht arm splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4025001003Cast supplies, hip spica (one or both legs), adult (11 years +), plaster        Cast sup hip spica plaster  52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4026001003Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass     Cast sup hip spica fiberglas52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4027001003Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster    Cast sup hip spica ped plstr52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4028001003Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass Cast sup hip spica ped fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4029001003Cast supplies, long leg cast, adult (11 years +), plaster                       Cast sup long leg plaster   52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4030001003Cast supplies, long leg cast, adult (11 years +), fiberglass                    Cast sup long leg fiberglass52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4031001003Cast supplies, long leg cast, pediatric (0-10 years), plaster                   Cast sup lng leg ped plaster52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4032001003Cast supplies, long leg cast, pediatric (0-10 years), fiberglass                Cast sup lng leg ped fbrgls 52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4033001003Cast supplies, long leg cylinder cast, adult (11 years +), plaster              Cast sup lng leg cylinder pl52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4034001003Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass           Cast sup lng leg cylinder fb52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4035001003Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster          Cast sup lngleg cylndr ped p52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4036001003Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass       Cast sup lngleg cylndr ped f52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4037001003Cast supplies, short leg cast, adult (11 years +), plaster                      Cast sup shrt leg plaster   52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4038001003Cast supplies, short leg cast, adult (11 years +), fiberglass                   Cast sup shrt leg fiberglass52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4039001003Cast supplies, short leg cast, pediatric (0-10 years), plaster                  Cast sup shrt leg ped plster52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4040001003Cast supplies, short leg cast, pediatric (0-10 years), fiberglass               Cast sup shrt leg ped fbrgls52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4041001003Cast supplies, long leg splint, adult (11 years +), plaster                     Cast sup lng leg splnt plstr52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4042001003Cast supplies, long leg splint, adult (11 years +), fiberglass                  Cast sup lng leg splnt fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4043001003Cast supplies, long leg splint, pediatric (0-10 years), plaster                 Cast sup lng leg splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4044001003Cast supplies, long leg splint, pediatric (0-10 years), fiberglass              Cast sup lng leg splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4045001003Cast supplies, short leg splint, adult (11 years +), plaster                    Cast sup sht leg splnt plstr52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4046001003Cast supplies, short leg splint, adult (11 years +), fiberglass                 Cast sup sht leg splnt fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4047001003Cast supplies, short leg splint, pediatric (0-10 years), plaster                Cast sup sht leg splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4048001003Cast supplies, short leg splint, pediatric (0-10 years), fiberglass             Cast sup sht leg splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4049001003Finger splint, static                                                           Finger splint, static       52      A                                                                                                     C                          D1A S      02001070120010701        N
Q4050001003Cast supplies, for unlisted types and materials of casts                        Cast supplies unlisted      57      A                                                                                                     C                          D1A S      02001070120010701        N
Q4051001003Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners,  Splint supplies misc        57      A                                                                                                     C                          D1A S      02001070120010701        N
Q4051002004padding and other supplies)
Q4074001003Iloprost, inhalation solution, fda-approved final product, non-compounded,      Iloprost non-comp unit dose 51      A                                                                                                     C                          D1G 1P     02010010120100101        N
Q4074002004administered through dme, unit dose form, up to 20 micrograms
Q4080001003Iloprost, inhalation solution, fda-approved final product, non-compounded,      Iloprost non-comp unit dose 51      A                                                                                                     C                          D1G 1P     0200507012010010120091231N
Q4080002004administered through dme, unit dose form, 20 micrograms
Q4081001003Injection, epoetin alfa, 100 units (for esrd on dialysis)                       Epoetin alfa, 100 units ESRD57      A                  4273.1                                                                             D                          O1E 1L     02007010120070101        N
Q4082001003Drug or biological, not otherwise classified, part b drug competitive           Drug/bio NOC part B drug CAP51      A                                                                                                     C                          D1E 1L     02007010120070101        N
Q4082002004acquisition program (cap)
Q4100001003Skin substitute, not otherwise specified                                        Skin substitute, NOS        51      A                                                                                                     C                          O1E 1      02009010120090101        N
Q4101001003Apligraf, per square centimeter                                                 Apligraf                    51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4102001003Oasis wound matrix, per square centimeter                                       Oasis wound matrix          51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4103001003Oasis burn matrix, per square centimeter                                        Oasis burn matrix           51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4104001003Integra bilayer matrix wound dressing (bmwd), per square centimeter             Integra BMWD                51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4105001003Integra dermal regeneration template (drt), per square centimeter               Integra DRT                 51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4106001003Dermagraft, per square centimeter                                               Dermagraft                  51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4107001003Graftjacket, per square centimeter                                              Graftjacket                 51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4108001003Integra matrix, per square centimeter                                           Integra matrix              51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4109001003Skin substitute, tissuemend, per square centimeter                              Tissuemend skin sub         51      A                                                                                                     C                          O1E 1      0200901012011010120101231N
Q4110001003Primatrix, per square centimeter                                                Primatrix                   51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4111001003Gammagraft, per square centimeter                                               Gammagraft                  51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4112001003Cymetra, injectable, 1cc                                                        Cymetra injectable          51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4113001003Graftjacket xpress, injectable, 1cc                                             Graftjacket xpress          51      A                                                                                                     CYY20090101                O1E 1      02009010120110101        N
Q4114001003Integra flowable wound matrix, injectable, 1cc                                  Integra flowable wound matri51      A                                                                                                     CYY20090101                O1E 1      02009010120090101        N
Q4115001003Alloskin, per square centimeter                                                 Alloskin                    51      A                                                                                                     CYY20090701                O1E 1      02009070120110101        N
Q4116001003Alloderm, per square centimeter                                                 Alloderm                    51      A                                                                                                     CYY20090701                O1E 1      02009070120110101        N
Q4117001003Hyalomatrix, per square centimeter                                              Hyalomatrix                 51      A                                                                                                     C                          O1E 1      02011010120110101        N
Q4118001003Matristem micromatrix, 1 mg                                                     Matristem micromatrix       51      A                                                                                                     CYY20110101                O1E 1      02011010120110101        N
Q4119001003Matristem wound matrix, psmx, rs, or psm, per square centimeter                 Matristem wound matrix      51      A                                                                                                     CYY20120101                O1E 1      02011010120130101        C
Q4120001003Matristem burn matrix, per square centimeter                                    Matristem burn matrix       51      A                                                                                                     C                          O1E 1      02011010120110101        N
Q4121001003Theraskin, per square centimeter                                                Theraskin                   51      A                                                                                                     CYY20110101                O1E 1      02011010120110101        N
Q4122001003Dermacell, per square centimeter                                                Dermacell                   51      A                                                                                                     CYY20120101                O1E 1      02012010120120101        N
Q4123001003Alloskin rt, per square centimeter                                              Alloskin                    51      A                                                                                                     C                          O1E 1      02012010120120101        N
Q4124001003Oasis ultra tri-layer wound matrix, per square centimeter                       Oasis tri-layer wound matrix51      A                                                                                                     CYY20120101                O1E 1      02012010120120101        N
Q4125001003Arthroflex, per square centimeter                                               Arthroflex                  51      A                                                                                                     C                          O1E 1      02012010120120101        N
Q4126001003Memoderm, dermaspan, tranzgraft or integuply, per square centimeter             Memoderm/derma/tranz/integup51      A                                                                                                     C                          O1E 1      02012010120130101        C
Q4127001003Talymed, per square centimeter                                                  Talymed                     51      A                                                                                                     C                          O1E 1      02012010120120101        N
Q4128001003Flex hd, allopatch hd, or matrix hd, per square centimeter                      Flexhd/Allopatchhd/matrixhd 51      A                                                                                                     C                          O1E 1      02012010120130101        C
Q4129001003Unite biomatrix, per square centimeter                                          Unite biomatrix             51      A                                                                                                     C                          O1E 1      02012010120120101        N
Q4130001003Strattice tm, per square centimeter                                             Strattice TM                51      A                                                                                                     C                          O1E 1      02012010120120101        N
Q4131001003Epifix, per square centimeter                                                   Epifix                      51      A                                                                                                     CYY20130101                O1E 1      02013010120130101        A
Q4132001003Grafix core, per square centimeter                                              Grafix core                 51      A                                                                                                     CYY20130101                O1E 1      02013010120130101        A
Q4133001003Grafix prime, per square centimeter                                             Grafix prime                51      A                                                                                                     CYY20130101                O1E 1      02013010120130101        A
Q4134001003Hmatrix, per square centimeter                                                  hMatrix                     51      A                                                                                                     C                          O1E 1      02013010120130101        A
Q4135001003Mediskin, per square centimeter                                                 Mediskin                    51      A                                                                                                     C                          O1E 1      02013010120130101        A
Q4136001003Ez-derm, per square centimeter                                                  EZderm                      51      A                                                                                                     C                          O1E 1      02013010120130101        A
Q5001001003Hospice care provided in patient's home/residence                               Hospice in patient home     00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5002001003Hospice care provided in assisted living facility                               Hospice in assisted living  00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5003001003Hospice care provided in nursing long term care facility (ltc) or non-skilled   Hospice in LT/non-skilled NF00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5003002004nursing facility (nf)
Q5004001003Hospice care provided in skilled nursing facility (snf)                         Hospice in SNF              00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5005001003Hospice care provided in inpatient hospital                                     Hospice, inpatient hospital 00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5006001003Hospice care provided in inpatient hospice facility                             Hospice in hospice facility 00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5007001003Hospice care provided in long term care facility                                Hospice in LTCH             00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5008001003Hospice care provided in inpatient psychiatric facility                         Hospice in inpatient psych  00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5009001003Hospice care provided in place not otherwise specified (nos)                    Hospice care, NOS           00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N
Q5010001003Hospice home care provided in a hospice facility                                Hospice home care in hospice00      9                                                                                                     D                      0133Y2  1L     02010100120101001        N
Q9951001003Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per mlLOCM >= 400 mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        N
Q9953001003Injection, iron-based magnetic resonance contrast agent, per ml                 Inj Fe-based MR contrast,1ml57      A                  15022                                                                              D                          I1F 4      02005040120050401        N
Q9954001003Oral magnetic resonance contrast agent, per 100 ml                              Oral MR contrast, 100 ml    57      A                  15022                                                                              D                          I1F 4      02005040120050401        N
Q9955001003Injection, perflexane lipid microspheres, per ml                                Inj perflexane lip micros,ml57      A                                                                                                     C                          I1F 4      02005040120050401        N
Q9956001003Injection, octafluoropropane microspheres, per ml                               Inj octafluoropropane mic,ml57      A                                                                                                     C                          I1F 4      02005040120050401        N
Q9957001003Injection, perflutren lipid microspheres, per ml                                Inj perflutren lip micros,ml57      A                                                                                                     C                          I1F 4      02005040120050401        N
Q9958001003High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml    HOCM <=149 mg/ml iodine, 1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N
Q9959001003High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml      HOCM 150-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N
Q9960001003High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml      HOCM 200-249mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N
Q9961001003High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml      HOCM 250-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N
Q9962001003High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml      HOCM 300-349mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N
Q9963001003High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml      HOCM 350-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N
Q9964001003High osmolar contrast material, 400 or greater mg/ml iodine concentration, per  HOCM>= 400mg/ml iodine, 1ml 51      A                  15022                                                                              D                          I1E 4      02005070120050701        N
Q9964002004ml
Q9965001003Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml       LOCM 100-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02008010120080101        N
Q9966001003Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml       LOCM 200-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02008010120080101        N
Q9967001003Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml       LOCM 300-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02008010120080101        N
Q9968001003Injection, non-radioactive, non-contrast, visualization adjunct (e. G. ,        Visualization adjunct       51      A                                                                                                     CYY20130101                I1E 4      02010010120100101        N
Q9968002004methylene blue, isosulfan blue), 1 mg
Q9969001003Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per  Non-HEU TC-99M add-on/dose  53      A                                                                                                     D                      0179Y1  9      02013010120130101        A
Q9969002004study dose
R0070002003Transportation of portable x-ray equipment and personnel to home or nursing     Transport portable x-ray    13      A                  2070.4  5244.B                                                                     D                          I1F 4      01982010119980101        N
R0070003004home, per trip to facility or location, one patient seen
R0075001003Transportation of portable x-ray equipment and personnel to home or nursing     Transport port x-ray multipl13      A                  2070.4  5244.B                                                                     D                          I1F 4      01986010119980101        N
R0075002004home, per trip to facility or location, more than one patient seen
R0076001003Transportation of portable ekg to facility or location, per patient             Transport portable EKG      13      A50-15             2070.1  2070.4                                                                     D                      0061I1F 5      01984010119980101        N
S0012001003Butorphanol tartrate, nasal spray, 25 mg                                        Butorphanol tartrate, nasal 00      9                                                                                                     I                      0088Z2  1      02000010120000101        N
S0014001003Tacrine hydrochloride, 10 mg                                                    Tacrine hydrochloride, 10 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0017001003Injection, aminocaproic acid, 5 grams                                           Injection, aminocaproic acid00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0020001003Injection, bupivicaine hydrochloride, 30 ml                                     Injection, bupivicaine hydro00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0021001003Injection, cefoperazone sodium, 1 gram                                          Injection, cefoperazone sod 00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0023001003Injection, cimetidine hydrochloride, 300 mg                                     Injection, cimetidine hydroc00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0028001003Injection, famotidine, 20 mg                                                    Injection, famotidine, 20 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0030001003Injection, metronidazole, 500 mg                                                Injection, metronidazole    00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0032001003Injection, nafcillin sodium, 2 grams                                            Injection, nafcillin sodium 00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0034001003Injection, ofloxacin, 400 mg                                                    Injection, ofloxacin, 400 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0039001003Injection, sulfamethoxazole and trimethoprim, 10 ml                             Injection, sulfamethoxazole 00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0040001003Injection, ticarcillin disodium and clavulanate potassium, 3. 1 grams           Injection, ticarcillin disod00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0073001003Injection, aztreonam, 500 mg                                                    Injection, aztreonam, 500 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0074001003Injection, cefotetan disodium, 500 mg                                           Injection, cefotetan disodiu00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0077001003Injection, clindamycin phosphate, 300 mg                                        Injection, clindamycin phosp00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0078001003Injection, fosphenytoin sodium, 750 mg                                          Injection, fosphenytoin sodi00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0080001003Injection, pentamidine isethionate, 300 mg                                      Injection, pentamidine iseth00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0081001003Injection, piperacillin sodium, 500 mg                                          Injection, piperacillin sodi00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0088001003Imatinib, 100 mg                                                                Imatinib 100 mg             00      9                                                                                                     I                      0088Z2  9      02002010120081001        N
S0090001003Sildenafil citrate, 25 mg                                                       Sildenafil citrate, 25 mg   00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N
S0091001003Granisetron hydrochloride, 1mg (for circumstances falling under the medicare    Granisetron 1mg             00      9                                                                                                     I                      0088Z2  9      02002010120010701        N
S0091002004statute, use q0166)
S0092001003Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump) Hydromorphone 250 mg        00      9                                                                                                     I                      0088Z2  9      02002010120010701        N
S0093001003Injection, morphine sulfate, 500 mg (loading dose for infusion pump)            Morphine 500 mg             00      9                                                                                                     I                      0088Z2  9      02002010120010701        N
S0104001003Zidovudine, oral, 100 mg                                                        Zidovudine, oral, 100 mg    00      9                                                                                                     I                          Z2  1      02002100120021001        N
S0106001003Bupropion hcl sustained release tablet, 150 mg, per bottle of 60 tablets        Bupropion HCL SR 60 tablets 00      9                                                                                                     I                          Z2  9      02002040120020401        N
S0108001003Mercaptopurine, oral, 50 mg                                                     Mercaptopurine 50 mg        00      9                                                                                                     I                          Z2  9      02002040120020401        N
S0109001003Methadone, oral, 5 mg                                                           Methadone oral 5mg          00      9                                                                                                     I                          Z2  9      02004100120041001        N
S0117001003Tretinoin, topical, 5 grams                                                     Tretinoin topical 5 g       00      9                                                                                                     I                          Z2  9      02004070120040701        N
S0119001003Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute,  Ondansetron 4 mg            00      9                                                                                                     I                          Z2  9      02012010120120101        N
S0119002004use hcpcs q code)
S0122001003Injection, menotropins, 75 iu                                                   Inj menotropins 75 iu       00      9                                                                                                     I                          Z2  1P     02002040120020401        N
S0126001003Injection, follitropin alfa, 75 iu                                              Inj follitropin alfa 75 iu  00      9                                                                                                     I                          Z2  1P     02002040120020401        N
S0128001003Injection, follitropin beta, 75 iu                                              Inj follitropin beta 75 iu  00      9                                                                                                     I                          Z2  1P     02002040120020401        N
S0132001003Injection, ganirelix acetate, 250 mcg                                           Inj ganirelix acetat 250 mcg00      9                                                                                                     I                          Z2  1P     02002040120020401        N
S0136001003Clozapine, 25 mg                                                                Clozapine, 25 mg            00      9                                                                                                     I                          Z2  9      02003040120030401        N
S0137001003Didanosine (ddi), 25 mg                                                         Didanosine, 25 mg           00      9                                                                                                     I                          Z2  9      02003040120030401        N
S0138001003Finasteride, 5 mg                                                               Finasteride, 5 mg           00      9                                                                                                     I                          Z2  9      02003040120030401        N
S0139001003Minoxidil, 10 mg                                                                Minoxidil, 10 mg            00      9                                                                                                     I                          Z2  9      02003040120030401        N
S0140001003Saquinavir, 200 mg                                                              Saquinavir, 200 mg          00      9                                                                                                     I                          Z2  9      02003040120030401        N
S0142001003Colistimethate sodium, inhalation solution administered through dme,            Colistimethate inh sol mg   00      9                                                                                                     I                          Z2  9      02005040120050401        N
S0142002004concentrated form, per mg
S0145001003Injection, pegylated interferon alfa-2a, 180 mcg per ml                         Peg interferon alfa-2A/180  00      9                                                                                                     I                          Z2  9      02005070120050701        N
S0146001003Injection, pegylated interferon alfa-2b, 10 mcg per 0. 5 ml                     Peg interferon alfa-2b/10   00      9                                                                                                     I                          Z2  9      0200507012010100120100930N
S0148001003Injection, pegylated interferon alfa-2b, 10 mcg                                 Peg interferon alfa-2b/10   00      9                                                                                                     I                          Z2  9      02010100120101001        N
S0155001003Sterile dilutant for epoprostenol, 50ml                                         Epoprostenol dilutant       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0156001003Exemestane, 25 mg                                                               Exemestane, 25 mg           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0157001003Becaplermin gel 0. 01%, 0. 5 gm                                                 Becaplermin gel 1%, 0.5 gm  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0160001003Dextroamphetamine sulfate, 5 mg                                                 Dextroamphetamine           00      9                                                                                                     I                          Z2  9      02004040120040401        N
S0161001003Calcitrol, 0. 25 mg                                                             Calcitrol                   00      9                                                                                                     I                          Z2  9      0200404012010100120100930N
S0162001003Injection, efalizumab, 125 mg                                                   Injection efalizumab        00      9                                                                                                     I                          Z2  9      0200404012009100120090930N
S0164001003Injection, pantoprazole sodium, 40 mg                                           Injection pantroprazole     00      9                                                                                                     I                          Z2  9      02004040120040401        N
S0166001003Injection, olanzapine, 2. 5 mg                                                  Inj olanzapine 2.5mg        00      9                                                                                                     I                          Z2  9      02004100120041001        N
S0169001003Calcitrol, 0. 25 microgram                                                      Calcitrol                   00      9                                                                                                     I                          Z2  9      02010100120101001        N
S0170001003Anastrozole, oral, 1mg                                                          Anastrozole 1 mg            00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N
S0171001003Injection, bumetanide, 0. 5mg                                                   Bumetanide 0.5 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0172001003Chlorambucil, oral, 2mg                                                         Chlorambucil 2 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0174001003Dolasetron mesylate, oral 50mg (for circumstances falling under the medicare    Dolasetron 50 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0174002004statute, use q0180)
S0175001003Flutamide, oral, 125mg                                                          Flutamide 125 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0176001003Hydroxyurea, oral, 500mg                                                        Hydroxyurea 500 mg          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0177001003Levamisole hydrochloride, oral, 50mg                                            Levamisole 50 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0178001003Lomustine, oral, 10mg                                                           Lomustine 10 mg             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0179001003Megestrol acetate, oral, 20mg                                                   Megestrol 20 mg             00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N
S0181001003Ondansetron hydrochloride, oral, 4mg (for circumstances falling under the       Ondansetron 4 mg            00      9                                                                                                     I                      0088Z2  9      0200201012012010120111231N
S0181002004medicare statute, use q0179)
S0182001003Procarbazine hydrochloride, oral, 50mg                                          Procarbazine 5 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0183001003Prochlorperazine maleate, oral, 5mg (for circumstances falling under the        Prochlorperazine 5 mg       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0183002004medicare statute, use q0164 - q0165)
S0187001003Tamoxifen citrate, oral, 10mg                                                   Tamoxifen 10 mg             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0189001003Testosterone pellet, 75mg                                                       Testosterone pellet 75 mg   00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N
S0190001003Mifepristone, oral, 200 mg                                                      Mifepristone, oral, 200 mg  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0191001003Misoprostol, oral, 200 mcg                                                      Misoprostol, oral, 200 mcg  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0194001003Dialysis/stress vitamin supplement, oral, 100 capsules                          Vitamin suppl 100 caps      00      9                                                                                                     I                          Z2  9      02004040120040401        N
S0195001003Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from    Pneumo vaccine 5-9 yrs      00      9                                                                                                     I                          Z2  9      02003010120030101        N
S0195002004five years to nine years of age who have not previously received the vaccine
S0196001003Injectable poly-l-lactic acid, restorative implant, 1 ml, face (deep dermis,    Poly-l-lactic acid 1ml face 00      9                                                                                                     I                          Z2  9      0200501012010100120100930N
S0196002004subcutaneous layers)
S0197001003Prenatal vitamins, 30-day supply                                                Prenatal vitamins 30 day    00      9                                                                                                     I                          Z2  9      02005040120050401        N
S0199001003Medically induced abortion by oral ingestion of medication including all        Med abortion inc all ex drug00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0199002004associated services and supplies (e. G. , patient counseling, office visits,
S0199003004confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy,
S0199004004ultrasound to confirm completion of abortion) except drugs
S0201001003Partial hospitalization services, less than 24 hours, per diem                  Partial hospitalization serv00      9                                                                                                     I                          Z2  9      02002100120021001        N
S0207001003Paramedic intercept, non-hospital-based als service (non-voluntary),            Paramedicintercep nonhospals00      9                                                                                                     I                          Z2  9      02002100120021001        N
S0207002004non-transport
S0208001003Paramedic intercept, hospital-based als service (non-voluntary), non-transport  Paramed intrcept nonvol     00      9                                                                                                     I                      0088Z2  D      02002010120020101        N
S0209001003Wheelchair van, mileage, per mile                                               WC van mileage per mi       00      9                                                                                                     I                      0088Z2  D      02002010120020101        N
S0215001003Non-emergency transportation; mileage, per mile                                 Nonemerg transp mileage     00      9                                                                                                     I                      0088Z2  D      02002010120020401        N
S0220001003Medical conference by a physician with interdisciplinary team of health         Medical conference by physic00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0220002004professionals or representatives of community agencies to coordinate activities
S0220003004of patient care (patient is present); approximately 30 minutes
S0221001003Medical conference by a physician with interdisciplinary team of health         Medical conference, 60 min  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0221002004professionals or representatives of community agencies to coordinate activities
S0221003004of patient care (patient is present); approximately 60 minutes
S0250001003Comprehensive geriatric assessment and treatment planning performed by          Comp geriatr assmt team     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0250002004assessment team
S0255001003Hospice referral visit (advising patient and family of care options) performed  Hospice refer visit nonmd   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0255002004by nurse, social worker, or other designated staff
S0257001003Counseling and discussion regarding advance directives or end of life care      End of life counseling      00      9                                                                                                     I                          Z2  9      02005010120050101        N
S0257002004planning and decisions, with patient and/or surrogate (list separately in
S0257003004addition to code for appropriate evaluation and management service)
S0260001003History and physical (outpatient or office) related to surgical procedure (list H&P for surgery             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0260002004separately in addition to code for appropriate evaluation and management
S0260003004service)
S0265001003Genetic counseling, under physician supervision, each 15 minutes                Genetic counsel 15 mins     00      9                                                                                                     I                          Z2  9      02005070120050701        N
S0270001003Physician management of patient home care, standard monthly case rate (per 30   Home std case rate 30 days  00      9                                                                                                     I                          Z2  9      02007040120070401        N
S0270002004days)
S0271001003Physician management of patient home care, hospice monthly case rate (per 30    Home hospice case 30 days   00      9                                                                                                     I                          Z2  9      02007040120070401        N
S0271002004days)
S0272001003Physician management of patient home care, episodic care monthly case rate (per Home episodic case 30 days  00      9                                                                                                     I                          Z2  9      02007040120070401        N
S027200200430 days)
S0273001003Physician visit at member's home, outside of a capitation arrangement           MD home visit outside cap   00      9                                                                                                     I                          Z2  9      02007040120070401        N
S0274001003Nurse practitioner visit at member's home, outside of a capitation arrangement  Nurse practr visit outs cap 00      9                                                                                                     I                          Z2  9      02007040120070401        N
S0280001003Medical home program, comprehensive care coordination and planning, initial planMedical home, initial plan  00      9                                                                                                     I                          Z2  9      02010010120100101        N
S0281001003Medical home program, comprehensive care coordination and planning, maintenance Medical home, maintenance   00      9                                                                                                     I                          Z2  9      02010010120100101        N
S0281002004of plan
S0302001003Completed early periodic screening diagnosis and treatment (epsdt) service      Completed EPSDT             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0302002004(list in addition to code for appropriate evaluation and management service)
S0310001003Hospitalist services (list separately in addition to code for appropriate       Hospitalist visit           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0310002004evaluation and management service)
S0315001003Disease management program; initial assessment and initiation of the program    Disease management program  00      9                                                                                                     I                          Z2  9      02002100120021001        N
S0316001003Disease management program, follow-up/reassessment                              Follow-up/reassessment      00      9                                                                                                     I                          Z2  9      02002100120061001        N
S0317001003Disease management program; per diem                                            Disease mgmt per diem       00      9                                                                                                     I                          Z2  9      02003070120030701        N
S0320001003Telephone calls by a registered nurse to a disease management program member    RN telephone calls to DMP   00      9                                                                                                     I                          Z2  9      02002100120021001        N
S0320002004for monitoring purposes; per month
S0340001003Lifestyle modification program for management of coronary artery disease,       Lifestyle mod 1st stage     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0340002004including all supportive services; first quarter / stage
S0341001003Lifestyle modification program for management of coronary artery disease,       Lifestyle mod 2 or 3 stage  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0341002004including all supportive services; second or third quarter / stage
S0342001003Lifestyle modification program for management of coronary artery disease,       Lifestyle mod 4th stage     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0342002004including all supportive services; fourth quarter / stage
S0345001003Electrocardiographic monitoring utilizing a home computerized telemetry station Home ecg monitrng global 24h00      9                                                                                                     I                          Z2  9      0200604012010010120091231N
S0345002004with automatic activation and real-time notification of monitoring station,
S034500300424-hour attended monitoring, including recording, monitoring, receipt of
S0345004004transmissions, analysis, and physician review and interpretation; per 24-hour
S0345005004period
S0346001003Electrocardiographic monitoring utilizing a home computerized telemetry station Home ecg monitrng tech 24hr 00      9                                                                                                     I                          Z2  9      0200604012010010120091231N
S0346002004with automatic activation and real-time notification of monitoring station,
S034600300424-hour attended monitoring, including recording, monitoring, receipt of
S0346004004transmissions, and analysis; per 24-hour period
S0347001003Electrocardiographic monitoring utilizing a home computerized telemetry station Home ecg monitrng prof 24hr 00      9                                                                                                     I                          Z2  9      0200604012010010120091231N
S0347002004with automatic activation and real-time notification of monitoring station,
S034700300424-hour attended monitoring, including physician review and interpretation;
S034700400424-hour period
S0353001003Treatment planning and care coordination management for cancer, initial         Cancer treatmentplan initial00      9                                                                                                     I                          Z2  9      02012040120120401        A
S0353002004treatment
S0354001003Treatment planning and care coordination management for cancer, established     Cancer treatment plan change00      9                                                                                                     I                          Z2  9      02012040120120401        A
S0354002004patient with a change of regimen
S0390001003Routine foot care; removal and/or trimming of corns, calluses and/or nails and  Rout foot care per visit    00      9                                                                                                     I                          Z2  9      02002040120020401        N
S0390002004preventive maintenance in specific medical conditions (e. G. Diabetes), per
S0390003004visit
S0395001003Impression casting of a foot performed by a practitioner other than the         Impression casting ft       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0395002004manufacturer of the orthotic
S0400001003Global fee for extracorporeal shock wave lithotripsy treatment of kidney        Global eswl kidney          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0400002004stone(s)
S0500001003Disposable contact lens, per lens                                               Dispos cont lens            00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0504001003Single vision prescription lens (safety, athletic, or sunglass), per lens       Singl prscrp lens           00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0506001003Bifocal vision prescription lens (safety, athletic, or sunglass), per lens      Bifoc prscp lens            00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0508001003Trifocal vision prescription lens (safety, athletic, or sunglass), per lens     Trifoc prscrp lens          00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0510001003Non-prescription lens (safety, athletic, or sunglass),  per lens                Non-prscrp lens             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0512001003Daily wear specialty contact lens, per lens                                     Daily cont lens             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0514001003Color contact lens, per lens                                                    Color cont lens             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0515001003Scleral lens, liquid bandage device, per lens                                   Scleral lens liquid bandage 00      9                                                                                                     I                          Z2  9      02004100120041001        N
S0516001003Safety eyeglass frames                                                          Safety frames               00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0518001003Sunglasses frames                                                               Sunglass frames             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0580001003Polycarbonate lens (list this code in addition to the basic code for the lens)  Polycarb lens               00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0581001003Nonstandard lens (list this code in addition to the basic code for the lens)    Nonstnd lens                00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0590001003Integral lens service, miscellaneous services reported separately               Misc integral lens serv     00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0592001003Comprehensive contact lens evaluation                                           Comp cont lens eval         00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S0595001003Dispensing new spectacle lenses for patient supplied frame                      New lenses in pts old frame 00      9                                                                                                     I                          Z2  9      02005040120050401        N
S0596001003Phakic intraocular lens for correction of refractive error                      Phakic iol refractive error 00      9                                                                                                     I                          Z2  9      02012040120120401        A
S0601001003Screening proctoscopy                                                           Screening proctoscopy       00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S0605001003Digital rectal examination, male, annual                                        Digital rectal examination, 00      9                                                                                                     I                      0088Z2  9      0200001012010010120091231N
S0610001003Annual gynecological examination, new patient                                   Annual gynecological examina00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S0612001003Annual gynecological examination, established patient                           Annual gynecological examina00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S0613001003Annual gynecological examination; clinical breast examination without pelvic    Ann breast exam             00      9                                                                                                     I                          Z2  9      02005070120050701        N
S0613002004evaluation
S0618001003Audiometry for hearing aid evaluation to determine the level and degree of      Audiometry for hearing aid  00      9                                                                                                     I                          Z2  9      02004040120040401        N
S0618002004hearing loss
S0620001003Routine ophthalmological examination including refraction; new patient          Routine ophthalmological exa00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S0621001003Routine ophthalmological examination including refraction; established patient  Routine ophthalmological exa00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S0622001003Physical exam for college, new or established patient (list separately in       Phys exam for college       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S0622002004addition to appropriate evaluation and management code)
S0625001003Retinal telescreening by digital imaging of multiple different fundus areas to  Digital screening retina    00      9                                                                                                     I                          Z2  9      0200504012012010120111231N
S0625002004screen for vision-threatening conditions, including imaging, interpretation and
S0625003004report
S0630001003Removal of sutures; by a physician other than the physician who originally      Removal of sutures          00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S0630002004closed the wound
S0800001003Laser in situ keratomileusis (lasik)                                            Laser in situ keratomileusis00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S0810001003Photorefractive keratectomy (prk)                                               Photorefractive keratectomy 00      9                                                                                                     I                      0088Z2  29     02000010120000101        N
S0812001003Phototherapeutic keratectomy (ptk)                                              Phototherap keratect        00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N
S1001001003Deluxe item, patient aware (list in addition to code for basic item)            Deluxe item                 00      9                                                                                                     I                      0088Z2  P      02001070120010701        N
S1002001003Customized item (list in addition to code for basic item)                       Custom item                 00      9                                                                                                     I                      0088Z2  P      02001070120010701        N
S1015001003Iv tubing extension set                                                         IV tubing extension set     00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S1016001003Non-pvc (polyvinyl chloride) intravenous administration set, for use with drugs Non-pvc intravenous administ00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S1016002004that are not stable in pvc e. G. Paclitaxel
S1030001003Continuous noninvasive glucose monitoring device, purchase (for physician       Gluc monitor purchase       00      9                                                                                                     I                      0088Z2  PR     02002010120020101        N
S1030002004interpretation of data, use cpt code)
S1031001003Continuous noninvasive glucose monitoring device, rental, including sensor,     Gluc monitor rental         00      9                                                                                                     I                      0088Z2  APR    02002010120020101        N
S1031002004sensor replacement, and download to monitor (for physician interpretation of
S1031003004data, use cpt code)
S1040001003Cranial remolding orthosis, pediatric, rigid, with soft interface material,     Cranial remolding orthosis  00      9                                                                                                     I                          Z2  P      02002100120070101        N
S1040002004custom fabricated, includes fitting and adjustment(s)
S1090001003Mometasone furoate sinus implant, 370 micrograms                                Mometasone sinus implant    00      9                                                                                                     I                          Z2  9      02012070120120701        A
S2053001003Transplantation of small intestine and liver allografts                         Transplantation of small int00      9                                                                                                     I                      0088Z2  29     02000010120000101        N
S2054001003Transplantation of multivisceral organs                                         Transplantation of multivisc00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2055001003Harvesting of donor multivisceral organs, with preparation and maintenance of   Harvesting of donor multivis00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2055002004allografts; from cadaver donor
S2060001003Lobar lung transplantation                                                      Lobar lung transplantation  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2061001003Donor lobectomy (lung) for transplantation, living donor                        Donor lobectomy (lung)      00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2065001003Simultaneous pancreas kidney transplantation                                    Simult panc kidn trans      00      9                                                                                                     I                      0088Z2  2      02001070120010701        N
S2066001003Breast reconstruction with gluteal artery perforator (gap) flap, including      Breast GAP flap reconst     00      9                                                                                                     I                          Z2  2      02007070120070701        N
S2066002004harvesting of the flap, microvascular transfer, closure of donor site and
S2066003004shaping the flap into a breast, unilateral
S2067001003Breast reconstruction of a single breast with "stacked" deep inferior           Breast "stacked" DIEP/GAP   00      9                                                                                                     I                          Z2  2      02007070120070701        N
S2067002004epigastric perforator (diep) flap(s) and/or gluteal artery perforator (gap)
S2067003004flap(s), including harvesting of the flap(s), microvascular transfer, closure
S2067004004of donor site(s) and shaping the flap into a breast, unilateral
S2068001003Breast reconstruction with deep inferior epigastric perforator (diep) flap or   Breast DIEP or SIEA flap    00      9                                                                                                     I                          Z2  9      02006010120070701        N
S2068002004superficial inferior epigastric artery (siea) flap, including harvesting of the
S2068003004flap, microvascular transfer, closure of donor site and shaping the flap into a
S2068004004breast, unilateral
S2070001003Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with endoscopic laser   Cysto laser tx ureteral calc00      9                                                                                                     I                          Z2  9      02003100120031001        N
S2070002004treatment of ureteral calculi (includes ureteral catheterization)
S2079001003Laparoscopic esophagomyotomy (heller type)                                      Lap esophagomyotomy         00      9                                                                                                     I                          Z2  9      02006010120060101        N
S2080001003Laser-assisted uvulopalatoplasty (laup)                                         Laup                        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S2083001003Adjustment of gastric band diameter via subcutaneous port by injection or       Adjustment gastric band     00      9                                                                                                     I                          Z2  9      02004040120040401        N
S2083002004aspiration of saline
S2095001003Transcatheter occlusion or embolization for tumor destruction, percutaneous,    Transcath emboliz microspher00      9                                                                                                     I                          Z2  9      02004010120040101        N
S2095002004any method, using yttrium-90 microspheres
S2102001003Islet cell tissue transplant from pancreas; allogeneic                          Islet cell tissue transplant00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2103001003Adrenal tissue transplant to brain                                              Adrenal tissue transplant   00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2107001003Adoptive immunotherapy i. E. Development of specific anti-tumor reactivity (e.  Adoptive immunotherapy      00      9                                                                                                     I                          Z2  9      02002040120020401        N
S2107002004G. Tumor-infiltrating lymphocyte therapy) per course of treatment
S2112001003Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells)     Knee arthroscp harv         00      9                                                                                                     I                      0088Z2  2      02001070120010701        N
S2115001003Osteotomy, periacetabular, with internal fixation                               Periacetabular osteotomy    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S2117001003Arthroereisis, subtalar                                                         Arthroereisis, subtalar     00      9                                                                                                     I                          Z2  9      02005100120051001        N
S2118001003Metal-on-metal total hip resurfacing, including acetabular and femoral          Total hip resurfacing       00      9                                                                                                     I                          Z2  9      02008100120081001        N
S2118002004components
S2120001003Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal    Low density lipoprotein(LDL)00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2120002004ldl precipitation
S2140001003Cord blood harvesting for transplantation, allogeneic                           Cord blood harvesting       00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2142001003Cord blood-derived stem-cell transplantation, allogeneic                        Cord blood-derived stem-cell00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2150001003Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic   BMT harv/transpl 28d pkg    00      9                                                                                                     I                      0088Z2  9      02002010120040401        N
S2150002004or autologous, harvesting, transplantation, and related complications;
S2150003004including: pheresis and cell preparation/storage; marrow ablative therapy;
S2150004004drugs, supplies, hospitalization with outpatient follow-up; medical/surgical,
S2150005004diagnostic, emergency, and rehabilitative services; and the number of days of
S2150006004pre-and post-transplant care in the global definition
S2152001003Solid organ(s), complete or segmental, single organ or combination of organs;   Solid organ transpl pkg     00      9                                                                                                     I                          Z2  9      02004040120040401        N
S2152002004deceased or living donor (s), procurement, transplantation, and related
S2152003004complications; including: drugs; supplies; hospitalization with outpatient
S2152004004follow-up; medical/surgical, diagnostic, emergency, and rehabilitative
S2152005004services, and the number of days of pre- and post-transplant care in the global
S2152006004definition
S2202001003Echosclerotherapy                                                               Echosclerotherapy           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2205001003Minimally invasive direct coronary artery bypass surgery involving              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2205002004mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2205003004using arterial graft(s), single coronary arterial graft
S2206001003Minimally invasive direct coronary artery bypass surgery involving              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2206002004mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2206003004using arterial graft(s), two coronary arterial grafts
S2207001003Minimally invasive direct coronary artery bypass surgery involving              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2207002004mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2207003004using venous graft only, single coronary venous graft
S2208001003Minimally invasive direct coronary artery bypass surgery involving              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2208002004mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2208003004using single arterial and venous graft(s), single venous graft
S2209001003Minimally invasive direct coronary artery bypass surgery involving              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2209002004mini-thoracotomy or mini-sternotomy surgery, performed under direct vision;
S2209003004using two arterial grafts and single venous graft
S2225001003Myringotomy, laser-assisted                                                     Myringotomy laser-assist    00      9                                                                                                     I                          Z2  9      02004010120040101        N
S2230001003Implantation of magnetic component of semi-implantable hearing device on        Implant semi-imp hear       00      9                                                                                                     I                          Z2  9      02003100120031001        N
S2230002004ossicles in middle ear
S2235001003Implantation of auditory brain stem implant                                     Implant auditory brain imp  00      9                                                                                                     I                          Z2  9      02003100120031001        N
S2260001003Induced abortion, 17 to 24 weeks                                                Induced abortion 17-24 weeks00      9                                                                                                     I                      0088Z2  9      02002010120070101        N
S2265001003Induced abortion, 25 to 28 weeks                                                Induced abortion 25-28 wks  00      9                                                                                                     I                          Z2  9      02002100120070101        N
S2266001003Induced abortion, 29 to 31 weeks                                                Induced abortion 29-31 wks  00      9                                                                                                     I                          Z2  9      02002100120070101        N
S2267001003Induced abortion, 32 weeks or greater                                           Induced abortion 32 or more 00      9                                                                                                     I                          Z2  9      02002100120070101        N
S2270001003Insertion of vaginal cylinder for application of radiation source or clinical   Insertion vaginal cylinder  00      9                                                                                                     I                          Z2  9      0200810012011040120110331N
S2270002004brachytherapy (report separately in addition to radiation source delivery)
S2300001003Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy          Arthroscopy, shoulder, surgi00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2325001003Hip core decompression                                                          Hip core decompression      00      9                                                                                                     I                          Z2  9      02006100120061001        N
S2340001003Chemodenervation of abductor muscle(s) of vocal cord                            Chemodenervation of abductor00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S2341001003Chemodenervation of adductor muscle(s) of vocal cord                            Chemodenerv adduct vocal    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S2342001003Nasal endoscopy for post-operative debridement following functional endoscopic  Nasal endoscop po debrid    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S2342002004sinus surgery, nasal and/or sinus cavity(s), unilateral or bilateral
S2344001003Nasal/sinus endoscopy, surgical; with enlargement of sinus ostium opening using Endosc balloon sinuplasty   00      9                                                                                                     I                          Z2  9      0200701012011040120110331N
S2344002004inflatable device (i. E. , balloon sinuplasty)
S2348001003Decompression procedure, percutaneous, of nucleus pulposus of intervertebral    Decompress disc RF lumbar   00      9                                                                                                     I                          Z2  9      02005010120050101        N
S2348002004disc, using radiofrequency energy, single or multiple levels, lumbar
S2350001003Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s),   Diskectomy, anterior, with d00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2350002004including osteophytectomy; lumbar, single interspace
S2351001003Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s),   Diskectomy, anterior, with d00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S2351002004including osteophytectomy; lumbar, each additional interspace (list separately
S2351003004in addition to code for primary procedure)
S2360001003Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral        Vertebroplast cerv 1st      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S2360002004injection; cervical
S2361001003Each additional cervical vertebral body (list separately in addition to code    Vertebroplast cerv addl     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S2361002004for primary procedure)
S2400001003Repair, congenital diaphragmatic hernia in the fetus using temporary tracheal   Fetal surg congen hernia    00      9                                                                                                     I                      0088Z2  2      02002010120020401        N
S2400002004occlusion, procedure performed in utero
S2401001003Repair, urinary tract obstruction in the fetus, procedure performed in utero    Fetal surg urin trac obstr  00      9                                                                                                     I                      0088Z2  2      02002010120020101        N
S2402001003Repair, congenital cystic adenomatoid malformation in the fetus, procedure      Fetal surg cong cyst malf   00      9                                                                                                     I                      0088Z2  2      02002010120020101        N
S2402002004performed in utero
S2403001003Repair, extralobar pulmonary sequestration in the fetus, procedure performed in Fetal surg pulmon sequest   00      9                                                                                                     I                      0088Z2  2      02002010120020101        N
S2403002004utero
S2404001003Repair, myelomeningocele in the fetus, procedure performed in utero             Fetal surg myelomeningo     00      9                                                                                                     I                      0088Z2  2      02002010120020101        N
S2405001003Repair of sacrococcygeal teratoma in the fetus, procedure performed in utero    Fetal surg sacrococ teratoma00      9                                                                                                     I                          Z2  9      02002040120020401        N
S2409001003Repair, congenital malformation of fetus, procedure performed in utero, not     Fetal surg noc              00      9                                                                                                     I                      0088Z2  2      02002010120020101        N
S2409002004otherwise classified
S2411001003Fetoscopic laser therapy for treatment of twin-to-twin transfusion syndrome     Fetoscop laser ther TTTS    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S2900001003Surgical techniques requiring use of robotic surgical system (list separately   Robotic surgical system     00      9                                                                                                     I                          Z2  9      02005070120050701        N
S2900002004in addition to code for primary procedure)
S3000001003Diabetic indicator; retinal eye exam, dilated, bilateral                        Bilat dil retinal exam      00      9                                                                                                     I                          Z2  9      02003040120030401        N
S3005001003Performance measurement, evaluation of patient self assessment, depression      Eval self-assess depression 00      9                                                                                                     I                          Z2  9      02005040120050401        N
S3600001003Stat laboratory request (situations other than s3601)                           Stat lab                    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S3601001003Emergency stat laboratory charge for patient who is homebound or residing  in a Stat lab home/nf            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S3601002004nursing facility
S3620001003Newborn metabolic screening panel, includes test kit, postage and the           Newborn metabolic screening 00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S3620002004laboratory tests specified by the state for inclusion in this panel (e. G.
S3620003004Galactose; hemoglobin, electrophoresis;  hydroxyprogesterone, 17-d; phenylanine
S3620004004(pku); and thyroxine, total)
S3625001003Maternal serum triple marker screen including alpha-fetoprotein (afp), estriol, Maternal triple screen test 00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3625002004and human chorionic gonadotropin (hcg)
S3626001003Maternal serum quadruple marker screen including alpha-fetoprotein (afp),       Maternal serum quad screen  00      9                                                                                                     I                          Z2  9      02005100120051001        N
S3626002004estriol, human chorionic gonadotropin (hcg) and inhibin a
S3628001003Placental alpha microglobulin-1 rapid immunoassay for detection of rupture of   PAMG-1 rapid assay for ROM  00      9                                                                                                     I                          Z2  9      0200804012011070120110630N
S3628002004fetal membranes
S3630001003Eosinophil count, blood, direct                                                 Eosinophil blood count      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S3645001003Hiv-1 antibody testing of oral mucosal transudate                               HIV-1 antibody testing of or00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S3650001003Saliva test, hormone level; during menopause                                    Saliva test, hormone level; 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S3652001003Saliva test, hormone level; to assess preterm labor risk                        Saliva test, hormone level; 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S3655001003Antisperm antibodies test (immunobead)                                          Antisperm antibodies test   00      9                                                                                                     I                          Z2  9      02002100120021001        N
S3708001003Gastrointestinal fat absorption study                                           Gastrointestinal fat absorpt00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S3711001003Circulating tumor cell test                                                     Circulating tumor cell test 00      9                                                                                                     I                          Z2  9      0200901012012040120120331D
S3713001003Kras mutation analysis testing                                                  KRAS mutation analysis      00      9                                                                                                     I                          Z2  9      0200910012012040120120331D
S3721001003Prostate cancer antigen 3 (pca3) testing                                        Pca3 testing                00      9                                                                                                     I                          Z2  9      02012040120120401        A
S3722001003Dose optimization by area under the curve (auc) analysis, for infusional        Dose optimization AUC - 5FU 00      9                                                                                                     I                          Z2  9      02012010120120101        N
S37220020045-fluorouracil
S3800001003Genetic testing for amyotrophic lateral sclerosis (als)                         Genetic testing ALS         00      9                                                                                                     I                          Z2  9      02007070120070701        N
S3818001003Complete gene sequence analysis; brca1 gene                                     BRCA1 gene anal             00      9                                                                                                     I                      0088Z2  5      0200107012012040120120331D
S3819001003Complete gene sequence analysis; brca2 gene                                     BRCA2 gene anal             00      9                                                                                                     I                      0088Z2  5      0200107012012040120120331D
S3820001003Complete brca1 and brca2 gene sequence analysis for susceptibility to breast    Comp BRCA1/BRCA2            00      9                                                                                                     I                          Z2  9      0200304012012040120120331D
S3820002004and ovarian cancer
S3822001003Single mutation analysis (in individual with a known brca1 or brca2 mutation in Sing mutation brst/ovar     00      9                                                                                                     I                          Z2  9      0200304012012040120120331D
S3822002004the family) for susceptibility to breast and ovarian cancer
S3823001003Three-mutation brca1 and brca2 analysis for susceptibility to breast and        3 mutation brst/ovar        00      9                                                                                                     I                          Z2  9      0200304012013010120121231D
S3823002004ovarian cancer in ashkenazi individuals
S3828001003Complete gene sequence analysis; mlh1 gene                                      Comp MLH1 gene              00      9                                                                                                     I                          Z2  9      0200304012012040120120331D
S3829001003Complete gene sequence analysis; msh2 gene                                      Comp MSH2 gene              00      9                                                                                                     I                          Z2  9      0200304012012040120120331D
S3830001003Complete mlh1 and msh2 gene sequence analysis for hereditary nonpolyposis       Gene test HNPCC comp        00      9                                                                                                     I                      0088Z2  9      0200201012012040120120331D
S3830002004colorectal cancer (hnpcc) genetic testing
S3831001003Single-mutation analysis (in individual with a known mlh1 and msh2 mutation in  Gene test HNPCC single      00      9                                                                                                     I                      0088Z2  9      0200201012012040120120331D
S3831002004the family) for hereditary nonpolyposis colorectal cancer (hnpcc) genetic
S3831003004testing
S3833001003Complete apc gene sequence analysis for susceptibility to familial adenomatous  Comp APC sequence           00      9                                                                                                     I                          Z2  9      02003040120030401        N
S3833002004polyposis (fap) and attenuated fap
S3834001003Single-mutation analysis (in individual with a known apc mutation in the        Sing mutation APC           00      9                                                                                                     I                          Z2  9      02003040120030401        N
S3834002004family) for susceptibility to familial adenomatous polyposis (fap) and
S3834003004attenuated fap
S3835001003Complete gene sequence analysis for cystic fibrosis genetic testing             Gene test cystic fibrosis   00      9                                                                                                     I                      0088Z2  9      0200201012012040120120331D
S3837001003Complete gene sequence analysis for hemochromatosis genetic testing             Gene test hemochromato      00      9                                                                                                     I                      0088Z2  9      0200201012012040120120331D
S3840001003Dna analysis for germline mutations of the ret proto-oncogene for               DNA analysis RET-oncogene   00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3840002004susceptibility to multiple endocrine neoplasia type 2
S3841001003Genetic testing for retinoblastoma                                              Gene test retinoblastoma    00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3842001003Genetic testing for von hippel-lindau disease                                   Gene test Hippel-Lindau     00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3843001003Dna analysis of the f5 gene for susceptibility to factor v leiden thrombophilia DNA analysis factor v       00      9                                                                                                     I                          Z2  9      0200307012012040120120331D
S3844001003Dna analysis of the connexin 26 gene (gjb2) for susceptibility to congenital,   DNA analysis deafness       00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3844002004profound deafness
S3845001003Genetic testing for alpha-thalassemia                                           Gene test alpha-thalassemia 00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3846001003Genetic testing for hemoglobin e beta-thalassemia                               Gene test beta-thalassemia  00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3847001003Genetic testing for tay-sachs disease                                           Gene test Tay-Sachs         00      9                                                                                                     I                          Z2  9      0200307012012040120120331D
S3848001003Genetic testing for gaucher disease                                             Gene test Gaucher           00      9                                                                                                     I                          Z2  9      0200307012012040120120331D
S3849001003Genetic testing for niemann-pick disease                                        Gene test Niemann-Pick      00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3850001003Genetic testing for sickle cell anemia                                          Gene test sickle cell       00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3851001003Genetic testing for canavan disease                                             Gene test canavan           00      9                                                                                                     I                          Z2  9      0200307012012040120120331D
S3852001003Dna analysis for apoe epsilon 4 allele for susceptibility to alzheimer's diseaseDNA analysis APOE alzheimer 00      9                                                                                                     I                          Z2  9      02003070120030701        N
S3853001003Genetic testing for myotonic muscular dystrophy                                 Gene test myo musclr dyst   00      9                                                                                                     I                          Z2  9      02004010120040101        N
S3854001003Gene expression profiling panel for use in the management of breast cancer      Gene profile panel breast   00      9                                                                                                     I                          Z2  9      02006010120060101        N
S3854002004treatment
S3855001003Genetic testing for detection of mutations in the presenilin - 1 gene           Gene test presenilin-1 gene 00      9                                                                                                     I                          Z2  9      02007010120070101        N
S3860001003Genetic testing, comprehensive cardiac ion channel analysis, for variants in 5  Genet test cardiac ion-comp 00      9                                                                                                     I                          Z2  9      0200810012012040120120331D
S3860002004major cardiac ion channel genes for individuals with high index of suspicion
S3860003004for familial long qt syndrome (lqts) or related syndromes
S3861001003Genetic testing, sodium channel, voltage-gated, type v, alpha subunit (scn5a)   Genetic test brugada        00      9                                                                                                     I                          Z2  9      02008100120081001        N
S3861002004and variants for suspected brugada syndrome
S3862001003Genetic testing, family-specific ion channel analysis, for blood-relatives of   Genet test cardiac ion-spec 00      9                                                                                                     I                          Z2  9      0200810012012040120120331D
S3862002004individuals (index case) who have previously tested positive for a genetic
S3862003004variant of a cardiac ion channel syndrome using either one of the above test
S3862004004configurations or confirmed results from another laboratory
S3865001003Comprehensive gene sequence analysis for hypertrophic cardiomyopathy            Comp genet test hyp cardiomy00      9                                                                                                     I                          Z2  9      02009040120090401        N
S3866001003Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy   Spec gene test hyp cardiomy 00      9                                                                                                     I                          Z2  9      02009040120090401        N
S3866002004(hcm) in an individual with a known hcm mutation in the family
S3870001003Comparative genomic hybrization (cgh) microarray testing for developmental      CGH test developmental delay00      9                                                                                                     I                          Z2  9      02009040120090401        N
S3870002004delay, autism spectrum disorder and/or mental retardation
S3890001003Dna analysis, fecal, for colorectal cancer screening                            Fecal DNA analysis          00      9                                                                                                     I                          Z2  9      02004040120040401        N
S3900001003Surface electromyography (emg)                                                  Surface EMG                 00      9                                                                                                     I                      0088Z2  9      02001070120010701        N
S3902001003Ballistocardiogram                                                              Ballistocardiogram          00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S3904001003Masters two step                                                                Masters two step            00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S3905001003Non-invasive electrodiagnostic testing with automatic computerized hand-held    Auto handheld diag nerv test00      9                                                                                                     I                          Z2  9      0200707012011040120110331N
S3905002004device to stimulate and measure neuromuscular signals in diagnosing and
S3905003004evaluating systemic and entrapment neuropathies
S4005001003Interim labor facility global (labor occurring but not resulting in delivery)   Interim labor facility globa00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4011001003In vitro fertilization; including but not limited to identification and         IVF package                 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4011002004incubation of mature oocytes, fertilization with sperm, incubation of
S4011003004embryo(s), and subsequent visualization for determination of development
S4013001003Complete cycle, gamete intrafallopian transfer (gift), case rate                Compl GIFT case rate        00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4014001003Complete cycle, zygote intrafallopian transfer (zift), case rate                Compl ZIFT case rate        00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4015001003Complete in vitro fertilization cycle, not otherwise specified, case rate       Complete IVF nos case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020401        N
S4016001003Frozen in vitro fertilization cycle, case rate                                  Frozen IVF case rate        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4017001003Incomplete cycle, treatment cancelled prior to stimulation, case rate           IVF canc a stim case rate   00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4018001003Frozen embryo transfer procedure cancelled before transfer, case rate           F EMB trns canc case rate   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4020001003In vitro fertilization procedure cancelled before aspiration, case rate         IVF canc a aspir case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4021001003In vitro fertilization procedure cancelled after aspiration, case rate          IVF canc p aspir case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4022001003Assisted oocyte fertilization, case rate                                        Asst oocyte fert case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4023001003Donor egg cycle, incomplete, case rate                                          Incompl donor egg case rate 00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4025001003Donor services for in vitro fertilization (sperm or embryo), case rate          Donor serv IVF case rate    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4026001003Procurement of donor sperm from sperm bank                                      Procure donor sperm         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4027001003Storage of previously frozen embryos                                            Store prev froz embryos     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4028001003Microsurgical epididymal sperm aspiration (mesa)                                Microsurg epi sperm asp     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4030001003Sperm procurement and cryopreservation services; initial visit                  Sperm procure init visit    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4031001003Sperm procurement and cryopreservation services; subsequent visit               Sperm procure subs visit    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4035001003Stimulated intrauterine insemination (iui), case rate                           Stimulated IUI case rate    00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4037001003Cryopreserved embryo transfer, case rate                                        Cryo embryo transf case rate00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4040001003Monitoring and storage of cryopreserved embryos, per 30 days                    Monit store cryo embryo 30 d00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4042001003Management of ovulation induction (interpretation of diagnostic tests and       Ovulation mgmt per cycle    00      9                                                                                                     I                          Z2  9      02005010120050101        N
S4042002004studies, non-face-to-face medical management of the patient), per cycle
S4981001003Insertion of levonorgestrel-releasing intrauterine system                       Insert levonorgestrel ius   00      9                                                                                                     I                      0088Z2  2      02001070120010701        N
S4989001003Contraceptive intrauterine device (e. G. Progestacert iud), including implants  Contracept IUD              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4989002004and supplies
S4990001003Nicotine patches, legend                                                        Nicotine patch legend       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4991001003Nicotine patches, non-legend                                                    Nicotine patch nonlegend    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S4993001003Contraceptive pills for birth control                                           Contraceptive pills for bc  00      9                                                                                                     I                          Z2  9      02002040120020401        N
S4995001003Smoking cessation gum                                                           Smoking cessation gum       00      9                                                                                                     I                          Z2  9      02002040120020401        N
S5000001003Prescription drug, generic                                                      Prescription drug, generic  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S5001001003Prescription drug, brand name                                                   Prescription drug,brand name00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S50100010035% dextrose and 0. 45% normal saline, 1000 ml                                   5% dextrose and 0.45% saline00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S50110010035% dextrose in lactated ringer's, 1000 ml                                       5% dextrose in lactated ring00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S50120010035% dextrose with potassium chloride, 1000 ml                                    5% dextrose with potassium  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S50130010035% dextrose/0. 45% normal saline with potassium chloride and magnesium sulfate, 5%dextrose/0.45%saline1000ml00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S50130020041000 ml
S50140010035% dextrose/0. 45% normal saline with potassium chloride and magnesium sulfate, D5W/0.45NS w KCl and MGS04  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S50140020041500 ml
S5035001003Home infusion therapy, routine service of infusion device (e. G. Pump           HIT routine device maint    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5035002004maintenance)
S5036001003Home infusion therapy, repair of infusion device (e. G. Pump repair)            HIT device repair           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5100001003Day care services, adult; per 15 minutes                                        Adult daycare services 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5101001003Day care services, adult; per half day                                          Adult day care per half day 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5102001003Day care services, adult; per diem                                              Adult day care per diem     00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5105001003Day care services, center-based; services not included in program fee, per diem Centerbased day care perdiem00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5108001003Home care training to home care client, per 15 minutes                          Homecare train pt 15 min    00      9                                                                                                     I                          Z2  9      02003040120030401        N
S5109001003Home care training to home care client, per session                             Homecare train pt session   00      9                                                                                                     I                          Z2  9      02003040120030401        N
S5110001003Home care training, family; per 15 minutes                                      Family homecare training 15m00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5111001003Home care training, family; per session                                         Family homecare train/sessio00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5115001003Home care training, non-family; per 15 minutes                                  Nonfamily homecare train/15m00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5116001003Home care training, non-family; per session                                     Nonfamily HC train/session  00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5120001003Chore services; per 15 minutes                                                  Chore services per 15 min   00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5121001003Chore services; per diem                                                        Chore services per diem     00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5125001003Attendant care services; per 15 minutes                                         Attendant care service /15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5126001003Attendant care services; per diem                                               Attendant care service /diem00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5130001003Homemaker service, nos; per 15 minutes                                          Homaker service nos per 15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5131001003Homemaker service, nos; per diem                                                Homemaker service nos /diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5135001003Companion care, adult (e. G. Iadl/adl); per 15 minutes                          Adult companioncare per 15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5136001003Companion care, adult (e. G. Iadl/adl); per diem                                Adult companioncare per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5140001003Foster care, adult; per diem                                                    Adult foster care per diem  00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5141001003Foster care, adult; per month                                                   Adult foster care per month 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5145001003Foster care, therapeutic, child; per diem                                       Child fostercare th per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5146001003Foster care, therapeutic, child; per month                                      Ther fostercare child /month00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5150001003Unskilled respite care, not hospice; per 15 minutes                             Unskilled respite care /15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5151001003Unskilled respite care, not hospice; per diem                                   Unskilled respitecare /diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5160001003Emergency response system; installation and testing                             Emer response sys instal&tst00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5161001003Emergency response system; service fee, per month (excludes installation and    Emer rspns sys serv permonth00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5161002004testing)
S5162001003Emergency response system; purchase only                                        Emer rspns system purchase  00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5165001003Home modifications; per service                                                 Home modifications per serv 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5170001003Home delivered meals, including preparation; per meal                           Homedelivered prepared meal 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5175001003Laundry service, external, professional; per order                              Laundry serv,ext,prof,/order00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5180001003Home health respiratory therapy, initial evaluation                             HH respiratory thrpy in eval00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5181001003Home health respiratory therapy, nos, per diem                                  HH respiratory thrpy nos/day00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5185001003Medication reminder service, non-face-to-face; per month                        Med reminder serv per month 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5190001003Wellness assessment, performed by non-physician                                 Wellness assessment by nonph00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5199001003Personal care item, nos, each                                                   Personal care item nos each 00      9                                                                                                     I                          Z2  9      02003010120030101        N
S5497001003Home infusion therapy, catheter care / maintenance, not otherwise classified;   HIT cath care noc           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5497002004includes administrative services, professional pharmacy services, care
S5497003004coordination, and all necessary supplies and equipment (drugs and nursing
S5497004004visits coded separately), per diem
S5498001003Home infusion therapy, catheter care / maintenance, simple (single lumen),      HIT simple cath care        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5498002004includes administrative services, professional pharmacy services, care
S5498003004coordination and all necessary supplies and equipment, (drugs and nursing
S5498004004visits coded separately), per diem
S5501001003Home infusion therapy, catheter care / maintenance, complex (more than one      HIT complex cath care       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5501002004lumen), includes administrative services, professional pharmacy services, care
S5501003004coordination, and all necessary supplies and equipment (drugs and nursing
S5501004004visits coded separately), per diem
S5502001003Home infusion therapy, catheter care / maintenance, implanted access device,    HIT interim cath care       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5502002004includes administrative services, professional pharmacy services, care
S5502003004coordination and all necessary supplies and equipment, (drugs and nursing
S5502004004visits coded separately), per diem (use this code for interim maintenance of
S5502005004vascular access not currently in use)
S5517001003Home infusion therapy, all supplies necessary for restoration of catheter       HIT declotting kit          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5517002004patency or declotting
S5518001003Home infusion therapy, all supplies necessary for catheter repair               HIT cath repair kit         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5520001003Home infusion therapy, all supplies (including catheter) necessary for a        HIT picc insert kit         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5520002004peripherally inserted central venous catheter (picc) line insertion
S5521001003Home infusion therapy, all supplies (including catheter) necessary for a        HIT midline cath insert kit 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5521002004midline catheter insertion
S5522001003Home infusion therapy, insertion of peripherally inserted central venous        HIT picc insert no supp     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S5522002004catheter (picc), nursing services only (no supplies or catheter included)
S5523001003Home infusion therapy, insertion of midline venous catheter, nursing services   HIP midline cath insert kit 00      9                                                                                                     I                      0088Z2  9      02002010120060701        N
S5523002004only (no supplies or catheter included)
S5550001003Insulin, rapid onset, 5 units                                                   Insulin rapid 5 u           00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5551001003Insulin, most rapid onset (lispro or aspart); 5 units                           Insulin most rapid 5 u      00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5552001003Insulin, intermediate acting (nph or lente); 5 units                            Insulin intermed 5 u        00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5553001003Insulin, long acting; 5 units                                                   Insulin long acting 5 u     00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5560001003Insulin delivery device, reusable pen; 1. 5 ml size                             Insulin reuse pen 1.5 ml    00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5561001003Insulin delivery device, reusable pen; 3 ml size                                Insulin reuse pen 3 ml      00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5565001003Insulin cartridge for use in insulin delivery device other than pump; 150 units Insulin cartridge 150 u     00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5566001003Insulin cartridge for use in insulin delivery device other than pump; 300 units Insulin cartridge 300 u     00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5570001003Insulin delivery device, disposable pen (including insulin); 1. 5 ml size       Insulin dispos pen 1.5 ml   00      9                                                                                                     I                          Z2  9      02003100120031001        N
S5571001003Insulin delivery device, disposable pen (including insulin); 3 ml size          Insulin dispos pen 3 ml     00      9                                                                                                     I                          Z2  9      02003100120031001        N
S8030001003Scleral application of tantalum ring(s) for localization of lesions for proton  Tantalum ring application   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8030002004beam therapy
S8035001003Magnetic source imaging                                                         Magnetic source imaging     00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S8037001003Magnetic resonance cholangiopancreatography (mrcp)                              mrcp                        00      9                                                                                                     I                      0088Z2  4      02001070120010701        N
S8040001003Topographic brain mapping                                                       Topographic brain mapping   00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S8042001003Magnetic resonance imaging (mri), low-field                                     MRI low field               00      9                                                                                                     I                          Z2  9      02002040120020401        N
S8049001003Intraoperative radiation therapy (single administration)                        Intraoperative radiation the00      9                                                                                                     I                      0088Z2  9      0200001012012040120120331D
S8055001003Ultrasound guidance for multifetal pregnancy reduction(s), technical component  Us guidance fetal reduct    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8055002004(only to be used when the physician doing the reduction procedure does not
S8055003004perform the ultrasound, guidance is included in the cpt code for multifetal
S8055004004pregnancy reduction - 59866)
S8080001003Scintimammography (radioimmunoscintigraphy of the breast), unilateral,          Scintimammography           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S8080002004including supply of radiopharmaceutical
S8085001003Fluorine-18 fluorodeoxyglucose (f-18 fdg) imaging using dual-head coincidence   Fluorine-18 fluorodeoxygluco00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S8085002004detection system (non-dedicated pet scan)
S8092001003Electron beam computed tomography (also known as ultrafast ct, cine ct)         Electron beam computed tomog00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S8096001003Portable peak flow meter                                                        Portable peak flow meter    00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S8097001003Asthma kit (including but not limited to portable peak expiratory flow meter,   Asthma kit                  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8097002004instructional video, brochure, and/or spacer)
S8100001003Holding chamber or spacer for use with an inhaler or nebulizer; without mask    Spacer without mask         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8101001003Holding chamber or spacer for use with an inhaler or nebulizer; with mask       Spacer with mask            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8110001003Peak expiratory flow rate (physician services)                                  Peak expiratory flow rate (p00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S8120001003Oxygen contents, gaseous, 1 unit equals 1 cubic foot                            O2 contents gas cubic ft    00      9                                                                                                     I                          Z2  9      02003100120031001        N
S8121001003Oxygen contents, liquid, 1 unit equals 1 pound                                  O2 contents liquid lb       00      9                                                                                                     I                          Z2  9      02003100120031001        N
S8130001003Interferential current stimulator, 2 channel                                    Interferential stim 2 chan  00      9                                                                                                     I                          Z2  9      02012010120120101        N
S8131001003Interferential current stimulator, 4 channel                                    Interferential stim 4 chan  00      9                                                                                                     I                          Z2  9      02012010120120101        N
S8185001003Flutter device                                                                  Flutter device              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8186001003Swivel adaptor                                                                  Swivel adaptor              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8189001003Tracheostomy supply, not otherwise classified                                   Trach supply noc            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8190001003Electronic spirometer (or microspirometer)                                      Electronic spirometer       00      9                                                                                                     I                      0088Z2  9      0200201012009040120090331N
S8210001003Mucus trap                                                                      Mucus trap                  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S8262001003Mandibular orthopedic repositioning device, each                                Mandib ortho repos device   00      9                                                                                                     I                          Z2  9      02002040120020401        N
S8265001003Haberman feeder for cleft lip/palate                                            Haberman feeder             00      9                                                                                                     I                          Z2  9      02002040120020401        N
S8270001003Enuresis alarm, using auditory buzzer and/or vibration device                   Enuresis alarm              00      9                                                                                                     I                          Z2  9      02005070120050701        N
S8301001003Infection control supplies, not otherwise specified                             Infect control supplies NOS 00      9                                                                                                     I                          Z2  9      02004070120040701        N
S8415001003Supplies for home delivery of infant                                            Supplies for home delivery  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8420001003Gradient pressure aid (sleeve and glove combination), custom made               Custom gradient sleev/glov  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8421001003Gradient pressure aid (sleeve and glove combination), ready made                Ready gradient sleev/glov   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8422001003Gradient pressure aid (sleeve), custom made, medium weight                      Custom grad sleeve med      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8423001003Gradient pressure aid (sleeve), custom made, heavy weight                       Custom grad sleeve heavy    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8424001003Gradient pressure aid (sleeve), ready made                                      Ready gradient sleeve       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8425001003Gradient pressure aid (glove), custom made, medium weight                       Custom grad glove med       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8426001003Gradient pressure aid (glove), custom made, heavy weight                        Custom grad glove heavy     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8427001003Gradient pressure aid (glove), ready made                                       Ready gradient glove        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8428001003Gradient pressure aid (gauntlet), ready made                                    Ready gradient gauntlet     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8429001003Gradient pressure exterior wrap                                                 Gradient pressure wrap      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8430001003Padding for compression bandage, roll                                           Padding for comprssn bdg    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8431001003Compression bandage, roll                                                       Compression bandage         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S8450001003Splint, prefabricated, digit (specify digit by use of modifier)                 Splint digit                00      9                                                                                                     I                      0088Z2  P      02002010120020101        N
S8451001003Splint, prefabricated, wrist or ankle                                           Splint wrist or ankle       00      9                                                                                                     I                      0088Z2  P      02002010120020101        N
S8452001003Splint, prefabricated, elbow                                                    Splint elbow                00      9                                                                                                     I                      0088Z2  P      02002010120020101        N
S8460001003Camisole, post-mastectomy                                                       Camisole post-mast          00      9                                                                                                     I                          Z2  9      02003040120030401        N
S8490001003Insulin syringes (100 syringes, any size)                                       100 insulin syringes        00      9                                                                                                     I                      0088Z2  S      02002010120020101        N
S8930001003Electrical stimulation of auricular acupuncture points; each 15 minutes of      Auricular electrostimulation00      9                                                                                                     I                          Z2  9      02012040120120401        A
S8930002004personal one-on-one contact with the patient
S8940001003Equestrian/hippotherapy, per session                                            Hippotherapy per session    00      9                                                                                                     I                          Z2  9      02005040120050401        N
S8948001003Application of a modality (requiring constant provider attendance) to one or    Low-level laser trmt 15 min 00      9                                                                                                     I                          Z2  9      02004010120040101        N
S8948002004more areas; low-level laser; each 15 minutes
S8950001003Complex lymphedema therapy, each 15 minutes                                     Complex lymphedema therapy, 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S8990001003Physical or manipulative therapy performed for maintenance rather than          Pt or manip for maint       00      9                                                                                                     I                          Z2  9      02003040120030401        N
S8990002004restoration
S8999001003Resuscitation bag (for use by patient on artificial respiration during power    Resuscitation bag           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S8999002004failure or other catastrophic event)
S9001001003Home uterine monitor with or without associated nursing services                Home uterine monitor with or00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9007001003Ultrafiltration monitor                                                         Ultrafiltration monitor     00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S9015001003Automated eeg monitoring                                                        Automated EEG monitoring    00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S9024001003Paranasal sinus ultrasound                                                      Paranasal sinus ultrasound  00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9025001003Omnicardiogram/cardiointegram                                                   Omnicardiogram/cardiointegra00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S9034001003Extracorporeal shockwave lithotripsy for gall stones (if performed with ercp,   ESWL for gallstones         00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9034002004use 43265)
S9055001003Procuren or other growth factor preparation to promote wound healing            Procuren or other growth fac00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9056001003Coma stimulation per diem                                                       Coma stimulation per diem   00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9061001003Home administration of aerosolized drug therapy (e. G. , pentamidine);          Medical supplies and equipme00      9                                                                                                     I                      0088Z2  9      02001010120020101        N
S9061002004administrative services, professional pharmacy services, care coordination, all
S9061003004necessary supplies and equipment (drugs and nursing visits coded separately),
S9061004004per diem
S9075001003Smoking cessation treatment                                                     Smoking cessation treatment 00      9                                                                                                     I                      0088Z2  9      0200001012011070120110630N
S9083001003Global fee urgent care centers                                                  Urgent care center global   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9088001003Services provided in an urgent care center (list in addition to code for        Services provided in urgent 00      9                                                                                                     I                      0088Z2  9      02001010120020101        N
S9088002004service)
S9090001003Vertebral axial decompression, per session                                      Vertebral axial decompressio00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9097001003Home visit for wound care                                                       Home visit wound care       00      9                                                                                                     I                          Z2  9      02004100120041001        N
S9098001003Home visit, phototherapy services (e. G. Bili-lite), including equipment        Home phototherapy visit     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9098002004rental, nursing services, blood draw, supplies, and other services, per diem
S9109001003Congestive heart failure telemonitoring, equipment rental, including telescale, CHF telemonitoring month    00      9                                                                                                     I                      0088Z2  9      0200201012013010120121231D
S9109002004computer system and software, telephone connections, and maintenance, per month
S9110001003Telemonitoring of patient in their home, including all necessary equipment;     Telemonitoring/home per mnth00      9                                                                                                     I                          Z2  9      02013010120130101        A
S9110002004computer system, connections, and software; maintenance; patient education and
S9110003004support; per month
S9117001003Back school, per visit                                                          Back school visit           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9122001003Home health aide or certified nurse assistant, providing care in the home; per  Home health aide or certifie00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9122002004hour
S9123001003Nursing care, in the home; by registered nurse, per hour (use for general       Nursing care in home RN     00      9                                                                                                     I                      0088Z2  9      02000010120040101        N
S9123002004nursing care only, not to be used when cpt codes 99500-99602 can be used)
S9124001003Nursing care, in the home; by licensed practical nurse, per hour                Nursing care, in the home; b00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9125001003Respite care, in the home, per diem                                             Respite care, in the home, p00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9126001003Hospice care, in the home, per diem                                             Hospice care, in the home, p00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9127001003Social work visit, in the home, per diem                                        Social work visit, in the ho00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9128001003Speech therapy, in the home, per diem                                           Speech therapy, in the home,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9129001003Occupational therapy, in the home, per diem                                     Occupational therapy, in the00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9131001003Physical therapy; in the home, per diem                                         PT in the home per diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9140001003Diabetic management program, follow-up visit to non-md provider                 Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9141001003Diabetic management program, follow-up visit to md provider                     Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9145001003Insulin pump initiation, instruction in initial use of pump (pump not included) Insulin pump initiation     00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9150001003Evaluation by ocularist                                                         Evaluation by ocularist     00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9152001003Speech therapy, re-evaluation                                                   Speech therapy, re-eval     00      9                                                                                                     I                          Z2  9      02007070120070701        N
S9208001003Home management of preterm labor, including administrative services,            Home mgmt preterm labor     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9208002004professional pharmacy services, care coordination, and all necessary supplies
S9208003004or equipment (drugs and nursing visits coded separately), per diem (do not use
S9208004004this code with any home infusion per diem code)
S9209001003Home management of preterm premature rupture of membranes (pprom), including    Home mgmt PPROM             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9209002004administrative services, professional pharmacy services, care coordination, and
S9209003004all necessary supplies or equipment (drugs and nursing visits coded
S9209004004separately), per diem (do not use this code with any home infusion per diem
S9209005004code)
S9211001003Home management of gestational hypertension, includes administrative services,  Home mgmt gest hypertension 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9211002004professional pharmacy services, care coordination and all necessary supplies
S9211003004and equipment (drugs and nursing visits coded separately); per diem (do not use
S9211004004this code with any home infusion per diem code)
S9212001003Home management of postpartum hypertension, includes administrative services,   Hm postpar hyper per diem   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9212002004professional pharmacy services, care coordination, and all necessary supplies
S9212003004and equipment (drugs and nursing visits coded separately), per diem (do not use
S9212004004this code with any home infusion per diem code)
S9213001003Home management of preeclampsia, includes administrative services, professional Hm preeclamp per diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9213002004pharmacy services, care coordination, and all necessary supplies and equipment
S9213003004(drugs and nursing services coded separately); per diem (do not use this code
S9213004004with any home infusion per diem code)
S9214001003Home management of gestational diabetes, includes administrative services,      Hm gest dm per diem         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9214002004professional pharmacy services, care coordination, and all necessary supplies
S9214003004and equipment (drugs and nursing visits coded separately); per diem (do not use
S9214004004this code with any home infusion per diem code)
S9325001003Home infusion therapy, pain management infusion; administrative services,       HIT pain mgmt per diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9325002004professional pharmacy services, care coordination, and all necessary supplies
S9325003004and equipment, (drugs and nursing visits coded separately), per diem (do not
S9325004004use this code with s9326, s9327 or s9328)
S9326001003Home infusion therapy, continuous (twenty-four hours or more) pain management   HIT cont pain per diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9326002004infusion; administrative services, professional pharmacy services, care
S9326003004coordination and all necessary supplies and equipment (drugs and nursing visits
S9326004004coded separately), per diem
S9327001003Home infusion therapy, intermittent (less than twenty-four hours) pain          HIT int pain per diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9327002004management infusion; administrative services, professional pharmacy services,
S9327003004care coordination, and all necessary supplies and equipment (drugs and nursing
S9327004004visits coded separately), per diem
S9328001003Home infusion therapy, implanted pump pain management infusion; administrative  HIT pain imp pump diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9328002004services, professional pharmacy services, care coordination, and all necessary
S9328003004supplies and equipment (drugs and nursing visits coded separately), per diem
S9329001003Home infusion therapy, chemotherapy infusion; administrative services,          HIT chemo per diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9329002004professional pharmacy services, care coordination, and all necessary supplies
S9329003004and equipment (drugs and nursing visits coded separately), per diem (do not use
S9329004004this code with s9330 or s9331)
S9330001003Home infusion therapy, continuous (twenty-four hours or more) chemotherapy      HIT cont chem diem          00      9                                                                                                     I                          Z2  9      02002010120020101        N
S9330002004infusion; administrative services, professional pharmacy services, care
S9330003004coordination, and all necessary supplies and equipment (drugs and nursing
S9330004004visits coded separately), per diem
S9331001003Home infusion therapy, intermittent (less than twenty-four hours) chemotherapy  HIT intermit chemo diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9331002004infusion; administrative services, professional pharmacy services, care
S9331003004coordination, and all necessary supplies and equipment (drugs and nursing
S9331004004visits coded separately), per diem
S9335001003Home therapy, hemodialysis; administrative services, professional pharmacy      HT hemodialysis diem        00      9                                                                                                     I                          Z2  9      02003070120030701        N
S9335002004services, care coordination, and all necessary supplies and equipment (drugs
S9335003004and nursing services coded separately), per diem
S9336001003Home infusion therapy, continuous anticoagulant infusion therapy (e. G.         HIT cont anticoag diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9336002004Heparin), administrative services, professional pharmacy services, care
S9336003004coordination and all necessary supplies and equipment (drugs and nursing visits
S9336004004coded separately), per diem
S9338001003Home infusion therapy, immunotherapy, administrative services, professional     HIT immunotherapy diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9338002004pharmacy services, care coordination, and all necessary supplies and equipment
S9338003004(drugs and nursing visits coded separately), per diem
S9339001003Home therapy; peritoneal dialysis, administrative services, professional        HIT periton dialysis diem   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9339002004pharmacy services, care coordination and all necessary supplies and equipment
S9339003004(drugs and nursing visits coded separately), per diem
S9340001003Home therapy; enteral nutrition; administrative services, professional pharmacy HIT enteral per diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9340002004services, care coordination, and all necessary supplies and equipment (enteral
S9340003004formula and nursing visits coded separately), per diem
S9341001003Home therapy; enteral nutrition via gravity; administrative services,           HIT enteral grav diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9341002004professional pharmacy services, care coordination, and all necessary supplies
S9341003004and equipment (enteral formula and nursing visits coded separately), per diem
S9342001003Home therapy; enteral nutrition via pump; administrative services, professional HIT enteral pump diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9342002004pharmacy services, care coordination, and all necessary supplies and equipment
S9342003004(enteral formula and nursing visits coded separately), per diem
S9343001003Home therapy; enteral nutrition via bolus; administrative services,             HIT enteral bolus nurs      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9343002004professional pharmacy services, care coordination, and all necessary supplies
S9343003004and equipment (enteral formula and nursing visits coded separately), per diem
S9345001003Home infusion therapy, anti-hemophilic agent infusion therapy (e. G. Factor     HIT anti-hemophil diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9345002004viii); administrative services, professional pharmacy services, care
S9345003004coordination, and all necessary supplies and equipment (drugs and nursing
S9345004004visits coded separately), per diem
S9346001003Home infusion therapy, alpha-1-proteinase inhibitor (e. G. , prolastin);        HIT alpha-1-proteinas diem  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9346002004administrative services, professional pharmacy services, care coordination, and
S9346003004all necessary supplies and equipment (drugs and nursing visits coded
S9346004004separately), per diem
S9347001003Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or HIT longterm infusion diem  00      9                                                                                                     I                      0088Z2  9      02002010120030101        N
S9347002004subcutaneous infusion therapy (e. G. Epoprostenol); administrative services,
S9347003004professional pharmacy services, care coordination, and all necessary supplies
S9347004004and equipment (drugs and nursing visits coded separately), per diem
S9348001003Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e. G.  HIT sympathomim diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9348002004, dobutamine); administrative services, professional pharmacy services, care
S9348003004coordination, all necessary supplies and equipment (drugs and nursing visits
S9348004004coded separately), per diem
S9349001003Home infusion therapy, tocolytic infusion therapy; administrative services,     HIT tocolysis diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9349002004professional pharmacy services, care coordination, and all necessary supplies
S9349003004and equipment (drugs and nursing visits coded separately), per diem
S9351001003Home infusion therapy, continuous or intermittent anti-emetic infusion therapy; HIT cont antiemetic diem    00      9                                                                                                     I                      0088Z2  9      02002010120070401        N
S9351002004administrative services, professional pharmacy services, care coordination, and
S9351003004all necessary supplies and equipment (drugs and visits coded separately), per
S9351004004diem
S9353001003Home infusion therapy, continuous insulin infusion therapy; administrative      HIT cont insulin diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9353002004services, professional pharmacy services, care coordination, and all necessary
S9353003004supplies and equipment (drugs and nursing visits coded separately), per diem
S9355001003Home infusion therapy, chelation therapy; administrative services, professional HIT chelation diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9355002004pharmacy services, care coordination, and all necessary supplies and equipment
S9355003004(drugs and nursing visits coded separately), per diem
S9357001003Home infusion therapy, enzyme replacement intravenous therapy; (e. G.           HIT enzyme replace diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9357002004Imiglucerase); administrative services, professional pharmacy services, care
S9357003004coordination, and all necessary supplies and equipment (drugs and nursing
S9357004004visits coded separately), per diem
S9359001003Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e. G.   HIT anti-tnf per diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9359002004Infliximab); administrative services, professional pharmacy services, care
S9359003004coordination, and all necessary supplies and equipment (drugs and nursing
S9359004004visits coded separately), per diem
S9361001003Home infusion therapy, diuretic intravenous therapy; administrative services,   HIT diuretic infus diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9361002004professional pharmacy services, care coordination, and all necessary supplies
S9361003004and equipment (drugs and nursing visits coded separately), per diem
S9363001003Home infusion therapy, anti-spasmotic therapy; administrative services,         HIT anti-spasmotic diem     00      9                                                                                                     I                      0088Z2  9      02002010120041001        N
S9363002004professional pharmacy services, care coordination, and all necessary supplies
S9363003004and equipment (drugs and nursing visits coded separately), per diem
S9364001003Home infusion therapy, total parenteral nutrition (tpn); administrative         HIT tpn total diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9364002004services, professional pharmacy services, care coordination, and all necessary
S9364003004supplies and equipment including standard tpn formula (lipids, specialty amino
S9364004004acid formulas, drugs other than in standard formula and nursing visits coded
S9364005004separately), per diem (do not use with home infusion codes s9365-s9368 using
S9364006004daily volume scales)
S9365001003Home infusion therapy, total parenteral nutrition (tpn); one liter per day,     HIT tpn 1 liter diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9365002004administrative services, professional pharmacy services, care coordination, and
S9365003004all necessary supplies and equipment including standard tpn formula (lipids,
S9365004004specialty amino acid formulas, drugs other than in standard formula and nursing
S9365005004visits coded separately), per diem
S9366001003Home infusion therapy, total parenteral nutrition (tpn); more than one liter    HIT tpn 2 liter diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9366002004but no more than two liters per day, administrative services, professional
S9366003004pharmacy services, care coordination, and all necessary supplies and equipment
S9366004004including standard tpn formula (lipids, specialty amino acid formulas, drugs
S9366005004other than in standard formula and nursing visits coded separately), per diem
S9367001003Home infusion therapy, total parenteral nutrition (tpn); more than two liters   HIT tpn 3 liter diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9367002004but no more than three liters per day, administrative services, professional
S9367003004pharmacy services, care coordination, and all necessary supplies and equipment
S9367004004including standard tpn formula (lipids, specialty amino acid formulas, drugs
S9367005004other than in standard formula and nursing visits coded separately), per diem
S9368001003Home infusion therapy, total parenteral nutrition (tpn); more than three liters HIT tpn over 3l diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9368002004per day, administrative services, professional pharmacy services, care
S9368003004coordination, and all necessary supplies and equipment including standard tpn
S9368004004formula (lipids, specialty amino acid formulas, drugs other than in standard
S9368005004formula and nursing visits coded separately), per diem
S9370001003Home therapy, intermittent anti-emetic injection therapy; administrative        HT inj antiemetic diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9370002004services, professional pharmacy services, care coordination, and all necessary
S9370003004supplies and equipment (drugs and nursing visits coded separately), per diem
S9372001003Home therapy; intermittent anticoagulant injection therapy (e. G. Heparin);     HT inj anticoag diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9372002004administrative services, professional pharmacy services, care coordination, and
S9372003004all necessary supplies and equipment (drugs and nursing visits coded
S9372004004separately), per diem (do not use this code for flushing of infusion devices
S9372005004with heparin to maintain patency)
S9373001003Home infusion therapy, hydration therapy; administrative services, professional HIT hydra total diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9373002004pharmacy services, care coordination, and all necessary supplies and equipment
S9373003004(drugs and nursing visits coded separately), per diem (do not use with
S9373004004hydration therapy codes s9374-s9377 using daily volume scales)
S9374001003Home infusion therapy, hydration therapy; one liter per day, administrative     HIT hydra 1 liter diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9374002004services, professional pharmacy services, care coordination, and all necessary
S9374003004supplies and equipment (drugs and nursing visits coded separately), per diem
S9375001003Home infusion therapy, hydration therapy; more than one liter but no more than  HIT hydra 2 liter diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9375002004two liters per day, administrative services, professional pharmacy services,
S9375003004care coordination, and all necessary supplies and equipment (drugs and nursing
S9375004004visits coded separately), per diem
S9376001003Home infusion therapy, hydration therapy; more than two liters but no more than HIT hydra 3 liter diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9376002004three liters per day, administrative services, professional pharmacy services,
S9376003004care coordination, and all necessary supplies and equipment (drugs and nursing
S9376004004visits coded separately), per diem
S9377001003Home infusion therapy, hydration therapy; more than three liters per day,       HIT hydra over 3l diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9377002004administrative services, professional pharmacy services, care coordination, and
S9377003004all necessary supplies (drugs and nursing visits coded separately), per diem
S9379001003Home infusion therapy, infusion therapy, not otherwise classified;              HIT noc per diem            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9379002004administrative services, professional pharmacy services, care coordination, and
S9379003004all necessary supplies and equipment (drugs and nursing visits coded
S9379004004separately), per diem
S9381001003Delivery or service to high risk areas requiring escort or extra protection,    HIT high risk/escort        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9381002004per visit
S9401001003Anticoagulation clinic, inclusive of all services except laboratory tests, per  Anticoag clinic per session 00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9401002004session
S9430001003Pharmacy compounding and dispensing services                                    Pharmacy comp/disp serv     00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9433001003Medical food nutritionally complete, administered orally, providing 100% of     Medical food oral 100% nutr 00      9                                                                                                     I                          Z2  9      02009010120090101        N
S9433002004nutritional intake
S9434001003Modified solid food supplements for inborn errors of metabolism                 Mod solid food suppl        00      9                                                                                                     I                          Z2  9      02003040120030401        N
S9435001003Medical foods for inborn errors of metabolism                                   Medical foods for inborn err00      9                                                                                                     I                      0088Z2  9      02001010120010101        N
S9436001003Childbirth preparation/lamaze classes, non-physician provider, per session      Lamaze class                00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9437001003Childbirth refresher classes, non-physician provider, per session               Childbirth refresher class  00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9438001003Cesarean birth classes, non-physician provider, per session                     Cesarean birth class        00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9439001003Vbac (vaginal birth after cesarean) classes, non-physician provider, per sessionVBAC class                  00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9441001003Asthma education, non-physician provider, per session                           Asthma education            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9442001003Birthing classes, non-physician provider, per session                           Birthing class              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9443001003Lactation classes, non-physician provider, per session                          Lactation class             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9444001003Parenting classes, non-physician provider, per session                          Parenting class             00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9445001003Patient education, not otherwise classified, non-physician provider,            PT education noc individ    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9445002004individual, per session
S9446001003Patient education, not otherwise classified, non-physician provider, group, per PT education noc group      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9446002004session
S9447001003Infant safety (including cpr) classes, non-physician provider, per session      Infant safety class         00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9449001003Weight management classes, non-physician provider, per session                  Weight mgmt class           00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9451001003Exercise classes, non-physician provider, per session                           Exercise class              00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9452001003Nutrition classes, non-physician provider, per session                          Nutrition class             00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9453001003Smoking cessation classes, non-physician provider, per session                  Smoking cessation class     00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9454001003Stress management classes, non-physician provider, per session                  Stress mgmt class           00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9455001003Diabetic management program, group session                                      Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9460001003Diabetic management program, nurse visit                                        Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9465001003Diabetic management program, dietitian visit                                    Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9470001003Nutritional counseling, dietitian visit                                         Nutritional counseling, diet00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9472001003Cardiac rehabilitation program, non-physician provider, per diem                Cardiac rehabilitation progr00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9473001003Pulmonary rehabilitation program, non-physician provider, per diem              Pulmonary rehabilitation pro00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9474001003Enterostomal therapy by a registered nurse certified in enterostomal therapy,   Enterostomal therapy by a re00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9474002004per diem
S9475001003Ambulatory setting substance abuse treatment or detoxification services, per    Ambulatory setting substance00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9475002004diem
S9476001003Vestibular rehabilitation program, non-physician provider, per diem             Vestibular rehab per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N
S9480001003Intensive outpatient psychiatric services, per diem                             Intensive outpatient psychia00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9482001003Family stabilization services, per 15 minutes                                   Family stabilization 15 min 00      9                                                                                                     I                          Z2  9      02005010120050101        N
S9484001003Crisis intervention mental health services, per hour                            Crisis intervention per hour00      9                                                                                                     I                          Z2  9      02002070120020701        N
S9485001003Crisis intervention mental health services, per diem                            Crisis intervention mental h00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9490001003Home infusion therapy, corticosteroid infusion; administrative services,        HIT corticosteroid/diem     00      9                                                                                                     I                          Z2  9      02002070120020701        N
S9490002004professional pharmacy services, care coordination, and all necessary supplies
S9490003004and equipment (drugs and nursing visits coded separately), per diem
S9494001003Home infusion therapy, antibiotic, antiviral, or antifungal therapy;            HIT antibiotic total diem   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9494002004administrative services, professional pharmacy services, care coordination, and
S9494003004all necessary supplies and equipment (drugs and nursing visits coded
S9494004004separately), per diem (do not use this code with home infusion codes for hourly
S9494005004dosing schedules s9497-s9504)
S9497001003Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every HIT antibiotic q3h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S94970020043 hours; administrative services, professional pharmacy services, care
S9497003004coordination, and all necessary supplies and equipment (drugs and nursing
S9497004004visits coded separately), per diem
S9500001003Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every HIT antibiotic q24h diem    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S950000200424 hours; administrative services, professional pharmacy services, care
S9500003004coordination, and all necessary supplies and equipment (drugs and nursing
S9500004004visits coded separately), per diem
S9501001003Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every HIT antibiotic q12h diem    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S950100200412 hours; administrative services, professional pharmacy services, care
S9501003004coordination, and all necessary supplies and equipment (drugs and nursing
S9501004004visits coded separately), per diem
S9502001003Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every HIT antibiotic q8h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S95020020048 hours, administrative services, professional pharmacy services, care
S9502003004coordination, and all necessary supplies and equipment (drugs and nursing
S9502004004visits coded separately), per diem
S9503001003Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6       HIT antibiotic q6h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9503002004hours; administrative services, professional pharmacy services, care
S9503003004coordination, and all necessary supplies and equipment (drugs and nursing
S9503004004visits coded separately), per diem
S9504001003Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4       HIT antibiotic q4h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9504002004hours; administrative services, professional pharmacy services, care
S9504003004coordination, and all necessary supplies and equipment (drugs and nursing
S9504004004visits coded separately), per diem
S9529001003Routine venipuncture for collection of specimen(s), single home bound, nursing  Venipuncture home/snf       00      9                                                                                                     I                      0088Z2  5      02002010120020101        N
S9529002004home, or skilled nursing facility patient
S9537001003Home therapy; hematopoietic hormone injection therapy (e. G. Erythropoietin,    HT hem horm inj diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9537002004g-csf, gm-csf); administrative services, professional pharmacy services, care
S9537003004coordination, and all necessary supplies and equipment (drugs and nursing
S9537004004visits coded separately), per diem
S9538001003Home transfusion of blood product(s); administrative services, professional     HIT blood products diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9538002004pharmacy services, care coordination and all necessary supplies and equipment
S9538003004(blood products, drugs, and nursing visits coded separately), per diem
S9542001003Home injectable therapy, not otherwise classified, including administrative     HT inj noc per diem         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9542002004services, professional pharmacy services, care coordination, and all necessary
S9542003004supplies and equipment (drugs and nursing visits coded separately), per diem
S9558001003Home injectable therapy; growth hormone, including administrative services,     HT inj growth horm diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9558002004professional pharmacy services, care coordination, and all necessary supplies
S9558003004and equipment (drugs and nursing visits coded separately), per diem
S9559001003Home injectable therapy, interferon, including administrative services,         HIT inj interferon diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9559002004professional pharmacy services, care coordination, and all necessary supplies
S9559003004and equipment (drugs and nursing visits coded separately), per diem
S9560001003Home injectable therapy; hormonal therapy (e. G. ; leuprolide, goserelin),      HT inj hormone diem         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9560002004including administrative services, professional pharmacy services, care
S9560003004coordination, and all necessary supplies and equipment (drugs and nursing
S9560004004visits coded separately), per diem
S9562001003Home injectable therapy, palivizumab, including administrative services,        HT inj palivizumab diem     00      9                                                                                                     I                          Z2  9      02003010120030101        N
S9562002004professional pharmacy services, care coordination, and all necessary supplies
S9562003004and equipment (drugs and nursing visits coded separately), per diem
S9590001003Home therapy, irrigation therapy (e. G. Sterile irrigation of an organ or       HT irrigation diem          00      9                                                                                                     I                          Z2  9      02003010120030101        N
S9590002004anatomical cavity); including administrative services, professional pharmacy
S9590003004services, care coordination, and all necessary supplies and equipment (drugs
S9590004004and nursing visits coded separately), per diem
S9810001003Home therapy; professional pharmacy services for provision of infusion,         HT pharm per hour           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9810002004specialty drug administration, and/or disease state management, not otherwise
S9810003004classified, per hour (do not use this code with any per diem code)
S9900001003Services by a journal-listed christian science practitioner for the purpose of  Christian Sci Pract visit   00      9                                                                                                     I                          Z2  9      02002070120120101        N
S9900002004healing, per diem
S9970001003Health club membership, annual                                                  Health club membership yr   00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9975001003Transplant related lodging, meals and transportation, per diem                  Transplant related per diem 00      9                                                                                                     I                          Z2  9      02002040120020401        N
S9976001003Lodging, per diem, not otherwise classified                                     Lodging per diem            00      9                                                                                                     I                          Z2  9      02004040120040401        N
S9977001003Meals, per diem, not otherwise specified                                        Meals per diem              00      9                                                                                                     I                          Z2  9      02004040120040401        N
S9981001003Medical records copying fee, administrative                                     Med record copy admin       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9982001003Medical records copying fee, per page                                           Med record copy per page    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9986001003Not medically necessary service (patient is aware that service not medically    Not medically necessary svc 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9986002004necessary)
S9988001003Services provided as part of a phase i clinical trial                           Serv part of phase I trial  00      9                                                                                                     I                          Z2  9      02004040120040401        N
S9989001003Services provided outside of the united states of america (list in addition to  Services outside US         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N
S9989002004code(s) for services(s))
S9990001003Services provided as part of a phase ii clinical trial                          Services provided as part of00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9991001003Services provided as part of a phase iii clinical trial                         Services provided as part of00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9992001003Transportation costs to and from trial location and local transportation costs  Transportation costs to and 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9992002004(e. G. , fares for taxicab or bus) for clinical trial participant and one
S9992003004caregiver/companion
S9994001003Lodging costs (e. G. , hotel charges) for clinical trial participant and one    Lodging costs (e.g. hotel ch00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9994002004caregiver/companion
S9996001003Meals for clinical trial participant and one caregiver/companion                Meals for clinical trial par00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
S9999001003Sales tax                                                                       Sales tax                   00      9                                                                                                     I                      0088Z2  9      02000010120000101        N
T1000001003Private duty / independent nursing service(s) - licensed, up to 15 minutes      Private duty/independent nsg00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1001001003Nursing assessment / evaluation                                                 Nursing assessment/evaluatn 00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1002001003Rn services, up to 15 minutes                                                   RN services up to 15 minutes00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1003001003Lpn/lvn services, up to 15 minutes                                              LPN/LVN services up to 15min00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1004001003Services of a qualified nursing aide, up to 15 minutes                          Nsg aide service up to 15min00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1005001003Respite care services, up to 15 minutes                                         Respite care service 15 min 00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1006001003Alcohol and/or substance abuse services, family/couple counseling               Family/Couple Counseling    00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1007001003Alcohol and/or substance abuse services, treatment plan development and/or      Treatment Plan Development  00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1007002004modification
T1009001003Child sitting services for children of the individual receiving alcohol and/or  Child Sitting Services      00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1009002004substance abuse services
T1010001003Meals for individuals receiving alcohol and/or substance abuse services (when   Meals when Receive Services 00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1010002004meals not included in the program)
T1012001003Alcohol and/or substance abuse services, skills development                     Alcohol/Substance Abuse Skil00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1013001003Sign language or oral interpretive services, per 15 minutes                     Sign Lang/Oral Interpreter  00      9                                                                                                     I                          Z2  9      02001070120030101        N
T1014001003Telehealth transmission, per minute, professional services bill separately      Telehealth transmit, per min00      9                                                                                                     I                          Z2  9      02001070120010701        N
T1015001003Clinic visit/encounter, all-inclusive                                           Clinic service              00      9                                                                                                     I                          Z2  1      02002010120020101        N
T1016001003Case management, each 15 minutes                                                Case management             00      9                                                                                                     I                          Z2  9      02002070120020701        N
T1017001003Targeted case management, each 15 minutes                                       Targeted case management    00      9                                                                                                     I                          Z2  9      02002070120020701        N
T1018001003School-based individualized education program (iep) services, bundled           School-based IEP ser bundled00      9                                                                                                     I                          Z2  9      02002070120020701        N
T1019001003Personal care services, per 15 minutes, not for an inpatient or resident of a   Personal care ser per 15 min00      9                                                                                                     I                          Z2  9      02002070120020701        N
T1019002004hospital, nursing facility, icf/mr or imd, part of the individualized plan of
T1019003004treatment (code may not be used to identify services provided by home health
T1019004004aide or certified nurse assistant)
T1020001003Personal care services, per diem, not for an inpatient or resident of a         Personal care ser per diem  00      9                                                                                                     I                          Z2  9      02002070120020701        N
T1020002004hospital, nursing facility, icf/mr or imd, part of the individualized plan of
T1020003004treatment (code may not be used to identify services provided by home health
T1020004004aide or certified nurse assistant)
T1021001003Home health aide or certified nurse assistant, per visit                        HH Aide or cn aide per visit00      9                                                                                                     I                          Z2  9      02002070120020701        N
T1022001003Contracted home health agency services, all services provided under contract,   Contracted services per day 00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1022002004per day
T1023001003Screening to determine the appropriateness of consideration of an individual    Program intake assessment   00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1023002004for participation in a specified program, project or treatment protocol, per
T1023003004encounter
T1024001003Evaluation and treatment by an integrated, specialty team contracted to provide Team evaluation & management00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1024002004coordinated care to multiple or severely handicapped children, per encounter
T1025001003Intensive, extended multidisciplinary services provided in a clinic setting to  Ped compr care pkg, per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1025002004children with complex medical, physical, mental and psychosocial impairments,
T1025003004per diem
T1026001003Intensive, extended multidisciplinary services provided in a clinic setting to  Ped compr care pkg, per hour00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1026002004children with complex medical, physical, medical and psychosocial impairments,
T1026003004per hour
T1027001003Family training and counseling for child development, per 15 minutes            Family training & counseling00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1028001003Assessment of home, physical and family environment, to determine suitability   Home environment assessment 00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1028002004to meet patient's medical needs
T1029001003Comprehensive environmental lead investigation, not including laboratory        Dwelling lead investigation 00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1029002004analysis, per dwelling
T1030001003Nursing care, in the home, by registered nurse, per diem                        RN home care per diem       00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1031001003Nursing care, in the home, by licensed practical nurse, per diem                LPN home care per diem      00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1502001003Administration of oral, intramuscular and/or subcutaneous medication by health  Medication admin visit      00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1502002004care agency/professional, per visit
T1503001003Administration of medication, other than oral and/or injectable, by a health    Med admin, not oral/inject  00      9                                                                                                     I                          Z2  9      02007040120070401        N
T1503002004care agency/professional, per visit
T1505001003Electronic medication compliance management device, includes all components and Elec med comp dev, noc      00      9                                                                                                     I                          Z2  9      02011010120110101        N
T1505002004accessories, not otherwise classified
T1999001003Miscellaneous therapeutic items and supplies, retail purchases, not otherwise   NOC retail items andsupplies00      9                                                                                                     I                          Z2  9      02003010120030101        N
T1999002004classified; identify product in "remarks"
T2001001003Non-emergency transportation; patient attendant/escort                          N-et; patient attend/escort 00      9                                                                                                     I                          Z2  9      02002040120020401        N
T2002001003Non-emergency transportation; per diem                                          N-et; per diem              00      9                                                                                                     I                          Z2  9      02002040120020401        N
T2003001003Non-emergency transportation; encounter/trip                                    N-et; encounter/trip        00      9                                                                                                     I                          Z2  9      02002040120020401        N
T2004001003Non-emergency transport; commercial carrier, multi-pass                         N-et; commerc carrier pass  00      9                                                                                                     I                          Z2  9      02002040120020401        N
T2005001003Non-emergency transportation; stretcher van                                     N-et; stretcher van         00      9                                                                                                     I                          Z2  9      02002040120040701        N
T2007001003Transportation waiting time, air ambulance and non-emergency vehicle, one-half  Non-emer transport wait time00      9                                                                                                     I                          Z2  9      02003010120030101        N
T2007002004(1/2) hour increments
T2010001003Preadmission screening and resident review (pasrr) level i identification       PASRR Level I               00      9                                                                                                     I                      0112Z2  9      02003040120030401        N
T2010002004screening, per screen
T2011001003Preadmission screening and resident review (pasrr) level ii evaluation, per     PASRR Level II              00      9                                                                                                     I                      0113Z2  9      02003040120030401        N
T2011002004evaluation
T2012001003Habilitation, educational; waiver, per diem                                     Habil ed waiver, per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2013001003Habilitation, educational, waiver; per hour                                     Habil ed waiver per hour    00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2014001003Habilitation, prevocational, waiver; per diem                                   Habil prevoc waiver, per d  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2015001003Habilitation, prevocational, waiver; per hour                                   Habil prevoc waiver per hr  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2016001003Habilitation, residential, waiver; per diem                                     Habil res waiver per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2017001003Habilitation, residential, waiver; 15 minutes                                   Habil res waiver 15 min     00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2018001003Habilitation, supported employment, waiver; per diem                            Habil sup empl waiver/diem  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2019001003Habilitation, supported employment, waiver; per 15 minutes                      Habil sup empl waiver 15min 00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2020001003Day habilitation, waiver; per diem                                              Day habil waiver per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2021001003Day habilitation, waiver; per 15 minutes                                        Day habil waiver per 15 min 00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2022001003Case management, per month                                                      Case management, per month  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2023001003Targeted case management; per month                                             Targeted case mgmt per month00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2024001003Service assessment/plan of care development, waiver                             Serv asmnt/care plan waiver 00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2025001003Waiver services; not otherwise specified (nos)                                  Waiver service, nos         00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2026001003Specialized childcare, waiver; per diem                                         Special childcare waiver/d  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2027001003Specialized childcare, waiver; per 15 minutes                                   Spec childcare waiver 15 min00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2028001003Specialized supply, not otherwise specified, waiver                             Special supply, nos waiver  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2029001003Specialized medical equipment, not otherwise specified, waiver                  Special med equip, noswaiver00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2030001003Assisted living, waiver; per month                                              Assist living waiver/month  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2031001003Assisted living; waiver, per diem                                               Assist living waiver/diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2032001003Residential care, not otherwise specified (nos), waiver; per month              Res care, nos waiver/month  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2033001003Residential care, not otherwise specified (nos), waiver; per diem               Res, nos waiver per diem    00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2034001003Crisis intervention, waiver; per diem                                           Crisis interven waiver/diem 00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2035001003Utility services to support medical equipment and assistive technology/devices, Utility services waiver     00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2035002004waiver
T2036001003Therapeutic camping, overnight, waiver; each session                            Camp overnite waiver/session00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2037001003Therapeutic camping, day, waiver; each session                                  Camp day waiver/session     00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2038001003Community transition, waiver; per service                                       Comm trans waiver/service   00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2039001003Vehicle modifications, waiver; per service                                      Vehicle mod waiver/service  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2040001003Financial management, self-directed, waiver; per 15 minutes                     Financial mgt waiver/15min  00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2041001003Supports brokerage, self-directed, waiver; per 15 minutes                       Support broker waiver/15 min00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2042001003Hospice routine home care; per diem                                             Hospice routine home care   00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2043001003Hospice continuous home care; per hour                                          Hospice continuous home care00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2044001003Hospice inpatient respite care; per diem                                        Hospice respite care        00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2045001003Hospice general inpatient care; per diem                                        Hospice general care        00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2046001003Hospice long term care, room and board only; per diem                           Hospice long term care, r&b 00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2048001003Behavioral health; long-term care residential (non-acute care in a residential  Bh ltc res r&b, per diem    00      9                                                                                                     I                          Z2  9      02003100120031001        N
T2048002004treatment program where stay is typically longer than 30 days), with room and
T2048003004board, per diem
T2049001003Non-emergency transportation; stretcher van, mileage; per mile                  N-ET; stretcher van, mileage00      9                                                                                                     I                          Z2  9      02004070120040701        N
T2101001003Human breast milk processing, storage and distribution only                     Breast milk proc/store/dist 00      9                                                                                                     I                          Z2  9      02004010120040101        N
T4521001003Adult sized disposable incontinence product, brief/diaper, small, each          Adult size brief/diaper sm  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4522001003Adult sized disposable incontinence product, brief/diaper, medium, each         Adult size brief/diaper med 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4523001003Adult sized disposable incontinence product, brief/diaper, large, each          Adult size brief/diaper lg  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4524001003Adult sized disposable incontinence product, brief/diaper, extra large, each    Adult size brief/diaper xl  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4525001003Adult sized disposable incontinence product, protective underwear/pull-on,      Adult size pull-on sm       00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4525002004small size, each
T4526001003Adult sized disposable incontinence product, protective underwear/pull-on,      Adult size pull-on med      00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4526002004medium size, each
T4527001003Adult sized disposable incontinence product, protective underwear/pull-on,      Adult size pull-on lg       00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4527002004large size, each
T4528001003Adult sized disposable incontinence product, protective underwear/pull-on,      Adult size pull-on xl       00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4528002004extra large size, each
T4529001003Pediatric sized disposable incontinence product, brief/diaper, small/medium     Ped size brief/diaper sm/med00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4529002004size, each
T4530001003Pediatric sized disposable incontinence product, brief/diaper, large size, each Ped size brief/diaper lg    00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4531001003Pediatric sized disposable incontinence product, protective  underwear/pull-on, Ped size pull-on sm/med     00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4531002004small/medium size, each
T4532001003Pediatric sized disposable incontinence product, protective underwear/pull-on,  Ped size pull-on lg         00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4532002004large size, each
T4533001003Youth sized disposable incontinence product, brief/diaper, each                 Youth size brief/diaper     00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4534001003Youth sized disposable incontinence product, protective underwear/pull-on, each Youth size pull-on          00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4535001003Disposable liner/shield/guard/pad/undergarment, for incontinence, each          Disposable liner/shield/pad 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4536001003Incontinence product, protective underwear/pull-on, reusable, any size, each    Reusable pull-on any size   00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4537001003Incontinence product, protective underpad, reusable, bed size, each             Reusable underpad bed size  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4538001003Diaper service, reusable diaper, each diaper                                    Diaper serv reusable diaper 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4539001003Incontinence product, diaper/brief, reusable, any size, each                    Reuse diaper/brief any size 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4540001003Incontinence product, protective underpad, reusable, chair size, each           Reusable underpad chair size00      960-9                                                                                                 M                          D1A 9      02005010120050101        N
T4541001003Incontinence product, disposable underpad, large, each                          Large disposable underpad   00      9                                                                                                     I                          Z2  9      02005010120050101        N
T4542001003Incontinence product, disposable underpad, small size, each                     Small disposable underpad   00      9                                                                                                     I                          Z2  9      02005010120050101        N
T4543001003Disposable incontinence product, brief/diaper, bariatric, each                  Disp bariatric brief/diaper 00      960-9                                                                                                 M                          D1A 9      02007010120070101        N
T5001001003Positioning seat for persons with special orthopedic needs                      Position seat spec orth need00      9                                                                                                     I                          Z2  P      02004010120070101        N
T5999001003Supply, not otherwise specified                                                 Supply, nos                 00      9                                                                                                     I                          Z2  9      02004010120040101        N
V2020003003Frames, purchases                                                               Vision svcs frames purchases38      A                  2130                                                                               D                          D1F Q      01985010120031001        N
V2025001003Deluxe frame                                                                    Eyeglasses delux frames     00      9                  3045.4                                                                             M                          D1F Q      01992010120031001        N
V2100008003Sphere, single vision, plano to plus or minus 4. 00, per lens                   Lens spher single plano 4.0038      A                                                                                                     C                          D1F Q      01985010120031001        N
V2101001003Sphere, single vision, plus or minus 4. 12 to plus or minus 7. 00d, per lens    Single visn sphere 4.12-7.0038      A                                                                                                     C                          D1F Q      01985010120031001        N
V2102001003Sphere, single vision, plus or minus  7. 12 to plus or minus 20. 00d, per lens  Singl visn sphere 7.12-20.0038      A                                                                                                     C                          D1F Q      01985010120031001        N
V2103001003Spherocylinder, single vision, plano to plus or minus 4. 00d sphere,. 12 to 2.  Spherocylindr 4.00d/12-2.00d38      A                                                                                                     C                          D1F Q      01985010120031001        N
V210300200400d cylinder, per lens
V2104001003Spherocylinder, single vision, plano to plus or minus 4. 00d sphere, 2. 12 to   Spherocylindr 4.00d/2.12-4d 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V21040020044. 00d cylinder, per lens
V2105001003Spherocylinder, single vision, plano to plus or minus 4. 00d sphere, 4. 25 to   Spherocylinder 4.00d/4.25-6d38      A                                                                                                     C                          D1F Q      01985010120031001        N
V21050020046. 00d cylinder, per lens
V2106001003Spherocylinder, single vision, plano to plus or minus 4. 00d sphere, over 6.    Spherocylinder 4.00d/>6.00d 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V210600200400d cylinder, per lens
V2107001003Spherocylinder, single vision, plus or minus 4. 25 to plus or minus 7. 00       Spherocylinder 4.25d/12-2d  38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2107002004sphere,. 12 to 2. 00d cylinder, per lens
V2108001003Spherocylinder, single vision, plus or minus 4. 25d to plus or minus 7. 00d     Spherocylinder 4.25d/2.12-4d38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2108002004sphere, 2. 12 to 4. 00d cylinder, per lens
V2109001003Spherocylinder, single vision, plus or minus 4. 25 to plus or minus 7. 00d      Spherocylinder 4.25d/4.25-6d38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2109002004sphere, 4. 25 to 6. 00d  cylinder, per lens
V2110001003Spherocylinder, single vision, plus or minus 4. 25 to 7. 00d sphere, over 6.    Spherocylinder 4.25d/over 6d38      A                                                                                                     C                          D1F Q      01985010120031001        N
V211000200400d cylinder, per lens
V2111001003Spherocylinder, single vision, plus or minus 7. 25 to plus or minus 12. 00d     Spherocylindr 7.25d/.25-2.2538      A                                                                                                     C                          D1F Q      01985010120031001        N
V2111002004sphere,. 25 to 2. 25d cylinder, per lens
V2112001003Spherocylinder, single vision, plus or minus 7. 25 to plus or minus 12. 00d     Spherocylindr 7.25d/2.25-4d 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2112002004sphere, 2. 25d to 4. 00d cylinder, per lens
V2113001003Spherocylinder, single vision, plus or minus 7. 25 to plus or minus 12. 00d     Spherocylindr 7.25d/4.25-6d 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2113002004sphere, 4. 25 to 6. 00d cylinder, per lens
V2114001003Spherocylinder, single vision, sphere over plus or minus 12. 00d, per lens      Spherocylinder over 12.00d  38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2115001003Lenticular, (myodisc), per lens, single vision                                  Lens lenticular bifocal     38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2118001003Aniseikonic lens, single vision                                                 Lens aniseikonic single     38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2121001003Lenticular lens, per lens, single                                               Lenticular lens, single     38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2199001003Not otherwise classified, single vision lens                                    Lens single vision not oth c46      A                                                                                                     C                          D1F Q      01985010120031001        N
V2200004003Sphere, bifocal, plano to plus or minus 4. 00d, per lens                        Lens spher bifoc plano 4.00d38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2201001003Sphere, bifocal, plus or minus 4. 12 to plus or minus 7. 00d, per lens          Lens sphere bifocal 4.12-7.038      A                                                                                                     C                          D1F Q      01985010120031001        N
V2202001003Sphere, bifocal, plus or minus 7. 12 to plus or minus 20. 00d, per lens         Lens sphere bifocal 7.12-20.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2203001003Spherocylinder, bifocal, plano to plus or minus 4. 00d sphere,. 12 to 2. 00d    Lens sphcyl bifocal 4.00d/.138      A                                                                                                     C                          D1F Q      01985010120031001        N
V2203002004cylinder, per lens
V2204001003Spherocylinder, bifocal, plano to plus or minus 4. 00d sphere, 2. 12 to 4. 00d  Lens sphcy bifocal 4.00d/2.138      A                                                                                                     C                          D1F Q      01985010120031001        N
V2204002004cylinder, per lens
V2205001003Spherocylinder, bifocal, plano to plus or minus 4. 00d sphere, 4. 25 to 6. 00d  Lens sphcy bifocal 4.00d/4.238      A                                                                                                     C                          D1F Q      01985010120031001        N
V2205002004cylinder, per lens
V2206001003Spherocylinder, bifocal, plano to plus or minus 4. 00d sphere, over 6. 00d      Lens sphcy bifocal 4.00d/ove38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2206002004cylinder, per lens
V2207001003Spherocylinder, bifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere,.   Lens sphcy bifocal 4.25-7d/.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V220700200412 to 2. 00d cylinder, per lens
V2208001003Spherocylinder, bifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere, 2. Lens sphcy bifocal 4.25-7/2.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V220800200412 to 4. 00d cylinder, per lens
V2209001003Spherocylinder, bifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere, 4. Lens sphcy bifocal 4.25-7/4.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V220900200425 to  6. 00d cylinder, per lens
V2210001003Spherocylinder, bifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere,    Lens sphcy bifocal 4.25-7/ov38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2210002004over 6. 00d cylinder,per lens
V2211001003Spherocylinder, bifocal, plus or minus 7. 25 to plus or minus 12. 00d sphere,.  Lens sphcy bifo 7.25-12/.25-38      A                                                                                                     C                          D1F Q      01985010120031001        N
V221100200425 to 2. 25d cylinder, per lens
V2212001003Spherocylinder, bifocal, plus or minus 7. 25 to plus or minus 12. 00d sphere,   Lens sphcyl bifo 7.25-12/2.238      A                                                                                                     C                          D1F Q      01985010120031001        N
V22120020042. 25 to 4. 00d cylinder, per lens
V2213001003Spherocylinder, bifocal, plus or minus 7. 25 to plus or minus 12. 00d sphere,   Lens sphcyl bifo 7.25-12/4.238      A                                                                                                     C                          D1F Q      01985010120031001        N
V22130020044. 25 to 6. 00d cylinder, per lens
V2214001003Spherocylinder, bifocal, sphere over plus or minus 12. 00d, per lens            Lens sphcyl bifocal over 12.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2215001003Lenticular (myodisc), per lens, bifocal                                         Lens lenticular bifocal     38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2218001003Aniseikonic, per lens, bifocal                                                  Lens aniseikonic bifocal    38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2219001003Bifocal seg width over 28mm                                                     Lens bifocal seg width over 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2220001003Bifocal add over 3. 25d                                                         Lens bifocal add over 3.25d 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2221001003Lenticular lens, per lens, bifocal                                              Lenticular lens, bifocal    38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2299001003Specialty bifocal (by report)                                                   Lens bifocal speciality     46      A                                                                                                     C                          D1F Q      01985010120031001        N
V2300004003Sphere, trifocal, plano to plus or minus 4. 00d, per lens                       Lens sphere trifocal 4.00d  38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2301001003Sphere, trifocal, plus or minus 4. 12 to plus or minus 7. 00d, per lens         Lens sphere trifocal 4.12-7.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2302001003Sphere, trifocal, plus or minus 7. 12 to plus or minus 20. 00, per lens         Lens sphere trifocal 7.12-2038      A                                                                                                     C                          D1F Q      01985010120031001        N
V2303001003Spherocylinder, trifocal, plano to plus or minus  4. 00d sphere,. 12-2. 00d     Lens sphcy trifocal 4.0/.12-38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2303002004cylinder, per lens
V2304001003Spherocylinder, trifocal, plano to plus or minus 4. 00d sphere, 2. 25-4. 00d    Lens sphcy trifocal 4.0/2.2538      A                                                                                                     C                          D1F Q      01985010120031001        N
V2304002004cylinder, per lens
V2305001003Spherocylinder, trifocal, plano to plus or minus 4. 00d sphere, 4. 25 to 6. 00  Lens sphcy trifocal 4.0/4.2538      A                                                                                                     C                          D1F Q      01985010120031001        N
V2305002004cylinder, per lens
V2306001003Spherocylinder, trifocal, plano to plus or minus 4. 00d sphere, over 6. 00d     Lens sphcyl trifocal 4.00/>638      A                                                                                                     C                          D1F Q      01985010120031001        N
V2306002004cylinder, per lens
V2307001003Spherocylinder, trifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere,.  Lens sphcy trifocal 4.25-7/.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V230700200412 to 2. 00d cylinder, per lens
V2308001003Spherocylinder, trifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere,   Lens sphc trifocal 4.25-7/2.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V23080020042. 12 to 4. 00d cylinder, per lens
V2309001003Spherocylinder, trifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere,   Lens sphc trifocal 4.25-7/4.38      A                                                                                                     C                          D1F Q      01985010120031001        N
V23090020044. 25 to 6. 00d cylinder, per lens
V2310001003Spherocylinder, trifocal, plus or minus 4. 25 to plus or minus 7. 00d sphere,   Lens sphc trifocal 4.25-7/>638      A                                                                                                     C                          D1F Q      01985010120031001        N
V2310002004over 6. 00d cylinder, per lens
V2311001003Spherocylinder, trifocal, plus or minus 7. 25 to plus or minus 12. 00d sphere,. Lens sphc trifo 7.25-12/.25-38      A                                                                                                     C                          D1F Q      01985010120031001        N
V231100200425 to 2. 25d cylinder, per lens
V2312001003Spherocylinder, trifocal, plus or minus 7. 25 to plus or minus 12. 00d sphere,  Lens sphc trifo 7.25-12/2.2538      A                                                                                                     C                          D1F Q      01985010120031001        N
V23120020042. 25 to 4. 00d cylinder, per lens
V2313001003Spherocylinder, trifocal, plus or minus 7. 25 to plus or minus 12. 00d sphere,  Lens sphc trifo 7.25-12/4.2538      A                                                                                                     C                          D1F Q      01985010120031001        N
V23130020044. 25 to 6. 00d cylinder, per lens
V2314001003Spherocylinder, trifocal, sphere over plus or minus 12. 00d, per lens           Lens sphcyl trifocal over 1238      A                                                                                                     C                          D1F Q      01985010120031001        N
V2315001003Lenticular, (myodisc), per lens, trifocal                                       Lens lenticular trifocal    38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2318001003Aniseikonic lens, trifocal                                                      Lens aniseikonic trifocal   38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2319001003Trifocal seg width over 28 mm                                                   Lens trifocal seg width > 2838      A                                                                                                     C                          D1F Q      01985010120031001        N
V2320001003Trifocal add over 3. 25d                                                        Lens trifocal add over 3.25d38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2321001003Lenticular lens, per lens, trifocal                                             Lenticular lens, trifocal   38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2399001003Specialty trifocal (by report)                                                  Lens trifocal speciality    46      A                                                                                                     C                          D1F Q      01985010120031001        N
V2410003003Variable asphericity lens, single vision, full field, glass or plastic, per lensLens variab asphericity sing38      A                                                                                                     C                          D1F Q      01984010120031001        N
V2430001003Variable asphericity lens, bifocal, full field, glass or plastic, per lens      Lens variable asphericity bi38      A                                                                                                     C                          D1F Q      01984010120031001        N
V2499001003Variable sphericity lens, other type                                            Variable asphericity lens   46      A                                                                                                     C                          D1F Q      01984010120031001        N
V2500004003Contact lens, pmma, spherical, per lens                                         Contact lens pmma spherical 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2501001003Contact lens, pmma, toric or prism ballast, per lens                            Cntct lens pmma-toric/prism 38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2502001003Contact lens pmma, bifocal, per lens                                            Contact lens pmma bifocal   38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2503001003Contact lens, pmma, color vision deficiency, per lens                           Cntct lens pmma color vision38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2510001003Contact lens, gas permeable, spherical, per lens                                Cntct gas permeable sphericl38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2511001003Contact lens, gas permeable, toric, prism ballast, per lens                     Cntct toric prism ballast   38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2512001003Contact lens, gas permeable, bifocal, per lens                                  Cntct lens gas permbl bifocl38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2513001003Contact lens, gas permeable, extended wear, per lens                            Contact lens extended wear  38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2520001003Contact lens, hydrophilic, spherical, per lens                                  Contact lens hydrophilic    38      A45-7  65-1                                                                                           D                          D1F Q      01984010120031001        N
V2521001003Contact lens, hydrophilic, toric, or prism ballast, per lens                    Cntct lens hydrophilic toric38      A45-7  65-1                                                                                           D                          D1F Q      01985010120031001        N
V2522001003Contact lens, hydrophillic, bifocal, per lens                                   Cntct lens hydrophil bifocl 38      A45-7  65-1                                                                                           D                          D1F Q      01985010120031001        N
V2523001003Contact lens, hydrophilic, extended wear, per lens                              Cntct lens hydrophil extend 38      A45-7  65-1                                                                                           D                          D1F Q      01985010120031001        N
V2530001003Contact lens, scleral, gas impermeable, per lens (for contact lens              Contact lens gas impermeable38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2530002004modification, see 92325)
V2531001003Contact lens, scleral, gas permeable, per lens (for contact lens modification,  Contact lens gas permeable  38      A65-3                                                                                                 D                          D1F Q      01996010120031001        N
V2531002004see 92325)
V2599001003Contact lens, other type                                                        Contact lens/es other type  46      A                                                                                                     C                          D1F Q      01985010120031001        N
V2600004003Hand held low vision aids and other nonspectacle mounted aids                   Hand held low vision aids   46      A                                                                                                     C                          D1F Q      01985010120031001        N
V2610001003Single lens spectacle mounted low vision aids                                   Single lens spectacle mount 46      A                                                                                                     C                          D1F Q      01985010120031001        N
V2615001003Telescopic and other compound lens system, including distance vision            Telescop/othr compound lens 46      A                                                                                                     C                          D1F Q      01985010120031001        N
V2615002004telescopic, near vision telescopes and compound microscopic lens system
V2623001003Prosthetic eye, plastic, custom                                                 Plastic eye prosth custom   38      A                  2133                                                                               D                          D1F P      01985010120031001        N
V2624001003Polishing/resurfacing of ocular prosthesis                                      Polishing artifical eye     38      A                                                                                                     C                          D1F P      01993010120031001        N
V2625001003Enlargement of ocular prosthesis                                                Enlargemnt of eye prosthesis38      A                                                                                                     C                          D1F P      01993010120031001        N
V2626001003Reduction of ocular prosthesis                                                  Reduction of eye prosthesis 38      A                                                                                                     C                          D1F P      01993010120031001        N
V2627001003Scleral cover shell                                                             Scleral cover shell         38      A65-3                                                                                                 D                          D1F P      01993010120031001        N
V2628001003Fabrication and fitting of ocular conformer                                     Fabrication & fitting       38      A                                                                                                     C                          D1F P      01993010120031001        N
V2629001003Prosthetic eye, other type                                                      Prosthetic eye other type   46      A                                                                                                     C                          D1F P      01985010120031001        N
V2630002003Anterior chamber intraocular lens                                               Anter chamber intraocul lens52      A                  2130                                                                               D                          D1F Q      01985010120031001        N
V2631001003Iris supported intraocular lens                                                 Iris support intraoclr lens 52      A                  2130                                                                               D                          D1F Q      01985010120031001        N
V2632001003Posterior chamber intraocular lens                                              Post chmbr intraocular lens 52      A                  2130                                                                               D                          D1F Q      01985010120031001        N
V2700002003Balance lens, per lens                                                          Balance lens                38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2702001003Deluxe lens feature                                                             Deluxe lens feature         00      9                  2130B                                                                              M                          D1F Q      02005010120050101        N
V2710001003Slab off prism, glass or plastic, per lens                                      Glass/plastic slab off prism38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2715001003Prism, per lens                                                                 Prism lens/es               38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2718001003Press-on lens, fresnell prism, per lens                                         Fresnell prism press-on lens38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2730001003Special base curve, glass or plastic, per lens                                  Special base curve          38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2744001003Tint, photochromatic, per lens                                                  Tint photochromatic lens/es 38      A                  2130B                                                                              D                          D1F Q      01985010120031001        N
V2745001003Addition to lens; tint, any color, solid, gradient or equal, excludes           Tint, any color/solid/grad  38      A                  2130.B                                                                             D                          D1F Q      02004010120050101        N
V2745002004photochromatic, any lens material, per lens
V2750001003Anti-reflective coating, per lens                                               Anti-reflective coating     38      A                  2130B                                                                              D                          D1F Q      01985010120031001        N
V2755001003U-v lens, per lens                                                              UV lens/es                  38      A                  2130B                                                                              D                          D1F Q      01985010120031001        N
V2756001003Eye glass case                                                                  Eye glass case              00      9                                                                                                     C                          Z2  Q      02004010120070101        N
V2760001003Scratch resistant coating, per lens                                             Scratch resistant coating   38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2761001003Mirror coating, any type, solid, gradient or equal, any lens material, per lens Mirror coating              38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2762001003Polarization, any lens material, per lens                                       Polarization, any lens      38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2770001003Occluder lens, per lens                                                         Occluder lens/es            38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2780001003Oversize lens, per lens                                                         Oversize lens/es            38      A                                                                                                     C                          D1F Q      01985010120031001        N
V2781001003Progressive lens, per lens                                                      Progressive lens per lens   00      9                                                                                                     C                          D1F Q      01996010120031001        N
V2782001003Lens, index 1. 54 to 1. 65 plastic or 1. 60 to 1. 79 glass, excludes            Lens, 1.54-1.65 p/1.60-1.79g38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2782002004polycarbonate, per lens
V2783001003Lens, index greater than or equal to 1. 66 plastic or greater than or equal to  Lens, >= 1.66 p/>=1.80 g    38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V27830020041. 80 glass, excludes polycarbonate, per lens
V2784001003Lens, polycarbonate or equal, any index, per lens                               Lens polycarb or equal      38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2785001003Processing, preserving and transporting corneal tissue                          Corneal tissue processing   46      A                                                                                                     CYY20080101                D1F Q      01990010120031001        N
V2786001003Specialty occupational multifocal lens, per lens                                Occupational multifocal lens38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N
V2787001003Astigmatism correcting function of intraocular lens                             Astigmatism-correct function00      9                                          1862(a)(7)                                                 S                          Z2  Q      02008010120080101        N
V2788001003Presbyopia correcting function of intraocular lens                              Presbyopia-correct function 00      9                                          1862(a)(7)                                                 S                          Z2  Q      02006010120060101        N
V2790001003Amniotic membrane for surgical reconstruction, per procedure                    Amniotic membrane           57      A                                                                                                     C                          Z2  Q      02001010120031001        N
V2797001003Vision supply, accessory and/or service component of another hcpcs vision code  Vis item/svc in other code  00      9                                                                                                     C                          D1F Q      02004010120040101        N
V2799001003Vision service, miscellaneous                                                   Miscellaneous vision service46      A                                                                                                     C                          D1F Q      01985010120031001        N
V5008001003Hearing screening                                                               Hearing screening           00      9                  2320                                                                               M                          O1F K      01990010119950101        N
V5010001003Assessment for hearing aid                                                      Assessment for hearing aid  00      9                                          1862A7                                                     S                          O1F K      01984010119950101        N
V5011001003Fitting/orientation/checking of hearing aid                                     Hearing aid fitting/checking00      9                                          1862A7                                                     S                          O1F K      01990010119950101        N
V5014001003Repair/modification of a hearing aid                                            Hearing aid repair/modifying00      9                                          1862A7                                                     S                          O1F K      01990010119950101        N
V5020001003Conformity evaluation                                                           Conformity evaluation       00      9                                          1862A7                                                     S                          O1F K      01984010119950101        N
V5030001003Hearing aid, monaural, body worn, air conduction                                Body-worn hearing aid air   00      9                                          1862A7                                                     S                          O1F K      01986010119950101        N
V5040001003Hearing aid, monaural, body worn, bone conduction                               Body-worn hearing aid bone  00      9                                          1862A7                                                     S                          O1F K      01986010119950101        N
V5050001003Hearing aid, monaural, in the ear                                               Hearing aid monaural in ear 00      9                                          1862A7                                                     S                          O1F K      01982010120010101        N
V5060001003Hearing aid, monaural, behind the ear                                           Behind ear hearing aid      00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5070001003Glasses, air conduction                                                         Glasses air conduction      00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5080001003Glasses, bone conduction                                                        Glasses bone conduction     00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5090001003Dispensing fee, unspecified hearing aid                                         Hearing aid dispensing fee  00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5095001003Semi-implantable middle ear hearing prosthesis                                  Implant mid ear hearing pros00      9                                          1862A7                                                     S                          O1F K      02003010120030101        N
V5100001003Hearing aid, bilateral, body worn                                               Body-worn bilat hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5110001003Dispensing fee, bilateral                                                       Hearing aid dispensing fee  00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5120001003Binaural, body                                                                  Body-worn binaur hearing aid00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5130001003Binaural, in the ear                                                            In ear binaural hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5140001003Binaural, behind the ear                                                        Behind ear binaur hearing ai00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5150001003Binaural, glasses                                                               Glasses binaural hearing aid00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5160001003Dispensing fee, binaural                                                        Dispensing fee binaural     00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5170001003Hearing aid, cros, in the ear                                                   Within ear cros hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5180001003Hearing aid, cros, behind the ear                                               Behind ear cros hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5190001003Hearing aid, cros, glasses                                                      Glasses cros hearing aid    00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5200001003Dispensing fee, cros                                                            Cros hearing aid dispens fee00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5210001003Hearing aid, bicros, in the ear                                                 In ear bicros hearing aid   00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5220001003Hearing aid, bicros, behind the ear                                             Behind ear bicros hearing ai00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5230001003Hearing aid, bicros, glasses                                                    Glasses bicros hearing aid  00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5240001003Dispensing fee, bicros                                                          Dispensing fee bicros       00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N
V5241001003Dispensing fee, monaural hearing aid, any type                                  Dispensing fee, monaural    00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5242001003Hearing aid, analog, monaural, cic (completely in the ear canal)                Hearing aid, monaural, cic  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5243001003Hearing aid, analog, monaural, itc (in the canal)                               Hearing aid, monaural, itc  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5244001003Hearing aid, digitally programmable analog, monaural, cic                       Hearing aid, prog, mon, cic 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5245001003Hearing aid, digitally programmable, analog, monaural, itc                      Hearing aid, prog, mon, itc 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5246001003Hearing aid, digitally programmable analog, monaural, ite (in the ear)          Hearing aid, prog, mon, ite 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5247001003Hearing aid, digitally programmable analog, monaural, bte (behind the ear)      Hearing aid, prog, mon, bte 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5248001003Hearing aid, analog, binaural, cic                                              Hearing aid, binaural, cic  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5249001003Hearing aid, analog, binaural, itc                                              Hearing aid, binaural, itc  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5250001003Hearing aid, digitally programmable analog, binaural, cic                       Hearing aid, prog, bin, cic 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5251001003Hearing aid, digitally programmable analog, binaural, itc                       Hearing aid, prog, bin, itc 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5252001003Hearing aid, digitally programmable, binaural, ite                              Hearing aid, prog, bin, ite 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5253001003Hearing aid, digitally programmable, binaural, bte                              Hearing aid, prog, bin, bte 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5254001003Hearing aid, digital, monaural, cic                                             Hearing id, digit, mon, cic 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5255001003Hearing aid, digital, monaural, itc                                             Hearing aid, digit, mon, itc00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5256001003Hearing aid, digital, monaural, ite                                             Hearing aid, digit, mon, ite00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5257001003Hearing aid, digital, monaural, bte                                             Hearing aid, digit, mon, bte00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5258001003Hearing aid, digital, binaural, cic                                             Hearing aid, digit, bin, cic00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5259001003Hearing aid, digital, binaural, itc                                             Hearing aid, digit, bin, itc00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5260001003Hearing aid, digital, binaural, ite                                             Hearing aid, digit, bin, ite00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5261001003Hearing aid, digital, binaural, bte                                             Hearing aid, digit, bin, bte00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5262001003Hearing aid, disposable, any type, monaural                                     Hearing aid, disp, monaural 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5263001003Hearing aid, disposable, any type, binaural                                     Hearing aid, disp, binaural 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5264001003Ear mold/insert, not disposable, any type                                       Ear mold/insert             00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5265001003Ear mold/insert, disposable, any type                                           Ear mold/insert, disp       00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5266001003Battery for use in hearing device                                               Battery for hearing device  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5267001003Hearing aid or assistive listening device/supplies/accessories, not otherwise   Hearing aid sup/access/dev  00      9                                          1862A7                                                     S                          O1F K      02002010120130101        C
V5267002004specified
V5268001003Assistive listening device, telephone amplifier, any type                       ALD Telephone Amplifier     00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5269001003Assistive listening device, alerting, any type                                  Alerting device, any type   00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5270001003Assistive listening device, television amplifier, any type                      ALD, TV amplifier, any type 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5271001003Assistive listening device, television caption decoder                          ALD, TV caption decoder     00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5272001003Assistive listening device, tdd                                                 Tdd                         00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5273001003Assistive listening device, for use with cochlear implant                       ALD for cochlear implant    00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5274001003Assistive listening device, not otherwise specified                             ALD unspecified             00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5275001003Ear impression, each                                                            Ear impression              00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N
V5281001003Assistive listening device, personal fm/dm system, monaural, (1 receiver,       Ald fm/dm system, monaural  00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5281002004transmitter, microphone), any type
V5282001003Assistive listening device, personal fm/dm system, binaural, (2 receivers,      Ald fm/dm system binaural   00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5282002004transmitter, microphone), any type
V5283001003Assistive listening device, personal fm/dm neck, loop induction receiver        Ald neck, loop ind receiver 00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5284001003Assistive listening device, personal fm/dm, ear level receiver                  Ald FM/DM ear level receiver00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5285001003Assistive listening device, personal fm/dm, direct audio input receiver         Ald fm/dm aud input receiver00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5286001003Assistive listening device, personal blue tooth fm/dm receiver                  Ald blu tooth fm/dm receiver00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5287001003Assistive listening device, personal fm/dm receiver, not otherwise specified    Ald fm/dm receiver, NOS     00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5288001003Assistive listening device, personal fm/dm transmitter assistive listening      Ald fm/dm transmitter ald   00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5288002004device
V5289001003Assistive listening device, personal fm/dm adapter/boot coupling device for     Ald fm/dm adapt/boot couplin00      9                                          1862a7                                                     S                      0000O1F K      02013010120130101        A
V5289002004receiver, any type
V5290001003Assistive listening device, transmitter microphone, any type                    Ald transmitter microphone  00      9                                          1862a7                                                     S                          O1F K      02013010120130101        A
V5298001003Hearing aid, not otherwise classified                                           Hearing aid noc             00      9                                          1862A7                                                     S                          O1F K      02003010120030101        N
V5299001003Hearing service, miscellaneous                                                  Hearing service             13      A                  2320                                                                               D                          O1F K      01982010119950101        N
V5336001003Repair/modification of augmentative communicative system or device (excludes    Repair communication device 00      9                                          1862A7                                                     S                          O1F 1      01990010119910101        N
V5336002004adaptive hearing aid)
V5362001003Speech screening                                                                Speech screening            00      9                                          1862(a)(7)                                                 S                          O1F 1W     01990010120040101        N
V5363001003Language screening                                                              Language screening          00      9                                          1862(a)(7)                                                 S                          O1F 1W     01990010120040101        N
V5364001003Dysphagia screening                                                             Dysphagia screening         00      9                                          1862(a)(7)                                                 S                          O1F 1W     01990010120040101        N

