***Disclaimers *Inclusion or exclusion of a procedure, supply, product, or service does not imply any health insurance coverage or reimbursement policy.  *In some instances, brand names may appear in HCPCS descriptions.  These names have been included for indexing purposes only; their inclusion does not    convey endorsement of any particular brand.  A1001007Dressing for one wound Dressing for one wound C 2002070120020701 N A2001007Dressing for two wounds Dressing for two wounds C 2002070120020701 N A3001007Dressing for three wounds Dressing for three wounds C 2002070120020701 N A4001007Dressing for four wounds Dressing for four wounds C 2002070120020701 N A5001007Dressing for five wounds Dressing for five wounds C 2002070120020701 N A6001007Dressing for six wounds Dressing for six wounds C 2002070120020701 N A7001007Dressing for seven wounds Dressing for seven wounds C 2002070120020701 N A8001007Dressing for eight wounds Dressing for eight wounds C 2002070120020701 N A9001007Dressing for nine or more wounds Dressing for 9 or more wound C 2002070120020701 N AA001007Anesthesia services performed personally by anesthesiologist Anesthesia perf by anesgst 3350.5 D 1984010120010101 N AD001007Medical supervision by a physician: more than four concurrent anesthesia Md supervision, >4 anes proc 3350.5 D 1984010120010101 N AD002008procedures AE001007Registered dietician Registered dietician C 2005010120050101 N AF001007Specialty physician Specialty physician C 2005010120050101 N AG001007Primary physician Primary physician C 2005010120050101 N AH001007Clinical psychologist Clinical psychologist 2150 5112 D 1991010119970101 N AI001007Principal physician of record Principal physician of rec C 2010010120100101 N AJ001007Clinical social worker Clinical social worker 2152 5113 D 1991010119970101 N AK001007Non participating physician Non participating physician C 2005010120050101 N AM001007Physician, team member service Physician, team member svc 4105.7 QM D 0069 1991010119970101 N AO001007Alternate payment method declined by provider of service Prov declined alt pmt method C 2013100120131001 N AP001007Determination of refractive state was not performed in the course of diagnostic No dtmn of refractive state C 1984010119970101 N AP002008ophthalmological examination AQ001007Physician providing a service in an unlisted health professional shortage area Physician service hpsa area C 2006010120060101 N AQ002008(hpsa) AR001007Physician provider services in a physician scarcity area Physician scarcity area C 2005010120050101 N AS001007Physician assistant, nurse practitioner, or clinical nurse specialist services Assistant at surgery service C 0069 1988010119990101 N AS002008for assistant at surgery AT001007Acute treatment (this modifier should be used when reporting service 98940, Acute treatment C 1984010119980101 N AT00200898941, 98942) AU001007Item furnished in conjunction with a urological, ostomy, or tracheostomy supply Uro, ostomy or trach item C 2003010120030101 N AV001007Item furnished in conjunction with a prosthetic device, prosthetic or orthotic Item w prosthetic/orthotic C 2003010120030101 N AW001007Item furnished in conjunction with a surgical dressing Item w a surgical dressing C 2003010120030101 N AX001007Item furnished in conjunction with dialysis services Item w dialysis services C 0000 2003010120030101 N AY001007Item or service furnished to an esrd patient that is not for the treatment of Item/service not for esrd tx C 2011010120110101 N AY002008esrd AZ001007Physician providing a service in a dental health professional shortage area for Physician serv in dent hpsa I 2011010120110101 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 2003010120030101 N BL001007Special acquisition of blood and blood products Spec acquisition blood prods C 2005070120050701 N BO001007Orally administered nutrition, not by feeding tube Nutrition oral admin no tube C 2003010120030101 N BP001007The beneficiary has been informed of the purchase and rental options and has Bene electd to purchase item C 1992010119970101 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 1992010119970101 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 1992010119970101 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 2003010120030101 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 2003040120040101 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 1990010119970101 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 2004010120040101 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 2004010120040101 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 2004010120040101 N CF002008part of the composite rate and is separately billable CG001007Policy criteria applied Policy criteria applied C 2008070120080701 N CH0010070 percent impaired, limited or restricted 0 percent impaired, ltd, res D 0180 2013010120130101 N CI001007At least 1 percent but less than 20 percent impaired, limited or restricted 1 to <20 percent impaired D 0180 2013010120130101 N CJ001007At least 20 percent but less than 40 percent impaired, limited or restricted 20 to <40 percent impaired D 0180 2013010120130101 N CK001007At least 40 percent but less than 60 percent impaired, limited or restricted 40 to <60 percent impaired D 0180 2013010120130101 N CL001007At least 60 percent but less than 80 percent impaired, limited or restricted 60 to <80 percent impaired D 0180 2013010120130101 N CM001007At least 80 percent but less than 100 percent impaired, limited or restricted 80 to <100 percent impaired D 0180 2013010120130101 N CN001007100 percent impaired, limited or restricted 100 percent impaired, ltd D 0180 2013010120130101 N CO001007Outpatient occupational therapy services furnished in whole or in part by an Outpatient ot service by ota C 2019010120190101 A CO002008occupational therapy assistant CP001007Adjunctive service related to a procedure assigned to a comprehensive C-apc adjunctive service C 201601012018010120171231N CP002008ambulatory payment classification (c-apc) procedure, but reported on a CP003008different claim CQ001007Outpatient physical therapy services furnished in whole or in part by a Outpatient pt service by pta C 2019010120190101 A CQ002008physical therapist assistant CR001007Catastrophe/disaster related Catastrophe/disaster related C 2005082120050821 N CS001007Item or service related, in whole or in part, to an illness, injury, or Gulf oil 2010 spill related C 2011010120110101 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 CT001007Computed tomography services furnished using equipment that does not meet each Ct does not meet nema standa C 2016010120160101 N CT002008of the attributes of the national electrical manufacturers association (nema) CT003008xr-29-2013 standard E1001007Upper left, eyelid Upper left eyelid C 1995010119990101 N E2001007Lower left, eyelid Lower left eyelid C 1995010119990101 N E3001007Upper right, eyelid Upper right eyelid C 1995010119990101 N E4001007Lower right, eyelid Lower right eyelid C 1995010119990101 N EA001007Erythropoetic stimulating agent (esa) administered to treat anemia due to Esa, anemia, chemo-induced D 0147 2008010120080101 N EA002008anti-cancer chemotherapy EB001007Erythropoetic stimulating agent (esa) administered to treat anemia due to Esa, anemia, radio-induced D 0147 2008010120080101 N EB002008anti-cancer radiotherapy EC001007Erythropoetic stimulating agent (esa) administered to treat anemia not due to Esa, anemia, non-chemo/radio D 0147 2008010120080101 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 2008010120080101 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 Hct>39% or hgb>13g<3 cycle D 0145 2008010120080101 N EE00200813.0 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 1991010120000101 N EJ002008hyaluronate, infliximab EM001007Emergency reserve supply (for esrd benefit only) Emer reserve supply (esrd) 3045.7 D 1991010119970101 N EP001007Service provided as part of medicaid early periodic screening diagnosis and Medicaid epsdt program svc C 1987010119970101 N EP002008treatment (epsdt) program ER001007Items and services furnished by a provider-based, off-campus emergency Off-campus ed service C 2019010120190101 A ER002008department ET001007Emergency services Emergency services C 1984010120020101 N EX001007Expatriate beneficiary Expatriate beneficiary C 2015040120150401 N EY001007No physician or other licensed health care provider order for this item or No md order for item/service C 2003010120030101 N EY002008service F1001007Left hand, second digit Left hand, second digit C 1995010119990101 N F2001007Left hand, third digit Left hand, third digit C 1995010119990101 N F3001007Left hand, fourth digit Left hand, fourth digit C 1995010119990101 N F4001007Left hand, fifth digit Left hand, fifth digit C 1995010119990101 N F5001007Right hand, thumb Right hand, thumb C 1995010119990101 N F6001007Right hand, second digit Right hand, second digit C 1995010119990101 N F7001007Right hand, third digit Right hand, third digit C 1995010119990101 N F8001007Right hand, fourth digit Right hand, fourth digit C 1995010119990101 N F9001007Right hand, fifth digit Right hand, fifth digit C 1995010119990101 N FA001007Left hand, thumb Left hand, thumb C 1995010119990101 N FB001007Item provided without cost to provider, supplier or practitioner, or full Item provided without cost I 2006010120080101 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 2008010120080101 N FP001007Service provided as part of family planning program Svc part of family plan pgm C 1987010120050101 N FX001007X-ray taken using film X-ray taken using film C 2017010120170101 N FY001007X-ray taken using computed radiography technology/cassette-based imaging Computed radiography x-ray C 2018010120180101 N G0001007Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an Telestroke C 2019010120190101 A G0002008acute stroke G1001007Most recent urr reading of less than 60 Urr reading of less than 60 C 1997010119980101 N G2001007Most recent urr reading of 60 to 64.9 Urr reading of 60 to 64.9 C 1997010119980101 N G3001007Most recent urr reading of 65 to 69.9 Urr reading of 65 to 69.9 C 1997010119980101 N G4001007Most recent urr reading of 70 to 74.9 Urr reading of 70 to 74.9 C 1997010119970101 N G5001007Most recent urr reading of 75 or greater Urr reading of 75 or greater C 1997010119980101 N G6001007Esrd patient for whom less than six dialysis sessions have been provided in a Esrd patient <6 dialysis/mth C 1998050119980501 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 1999070119990701 N G7002008life threatening G8001007Monitored anesthesia care (mac) for deep complex, complicated, or markedly Monitored anesthesia care C 0083 1999070119990701 N G8002008invasive surgical procedure G9001007Monitored anesthesia care for patient who has history of severe Mac for at risk patient C 1999070119990701 N G9002008cardio-pulmonary condition GA001007Waiver of liability statement issued as required by payer policy, individual Liability waiver ind case C 1995010120110101 N GA002008case GB001007Claim being re-submitted for payment because it is no longer covered under a Claim resubmitted C 2002010120020101 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 1997010120010101 N GC002008teaching physician GD001007Units of service exceeds medically unlikely edit value and represents Unit of service > mue value C 2008010120080101 N GD002008reasonable and necessary services GE001007This service has been performed by a resident without the presence of a Resident prim care exception 4116 D 1997010119970101 N GE002008teaching physician under the primary care exception GF001007Non-physician (e.g. nurse practitioner (np), certified registered nurse Nonphysician serv c a hosp C 2003040120030401 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 2002010120020101 N GG002008the same patient, same day GH001007Diagnostic mammogram converted from screening mammogram on same day Diag mammo to screening mamo C 1998100119981001 N GJ001007"opt out" physician or practitioner emergency or urgent service Opt out provider of er srvc C 1998100119981001 N GK001007Reasonable and necessary item/service associated with a ga or gz modifier Actual item/service ordered C 2002010120080101 N GL001007Medically unnecessary upgrade provided instead of non-upgraded item, no charge, Upgraded item, no charge C 2002010120080101 N GL002008no advance beneficiary notice (abn) GM001007Multiple patients on one ambulance trip Multiple transports C 2002010120020101 N GN001007Services delivered under an outpatient speech language pathology plan of care Op speech language service C 1999010120030101 N GO001007Services delivered under an outpatient occupational therapy plan of care Op occupational therapy serv C 1999010120030101 N GP001007Services delivered under an outpatient physical therapy plan of care Op pt services C 1999010120030101 N GQ001007Via asynchronous telecommunications system Telehealth store and forward C 2001100120011001 N GR001007This service was performed in whole or in part by a resident in a department of Service by va resident C 2006010120060101 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 2006010120130101 N GS002008response to hematocrit or hemoglobin level GT001007Via interactive audio and video telecommunication systems Interactivetelecommunication D 0073 1999010119990101 N GU001007Waiver of liability statement issued as required by payer policy, routine noticeLiability waiver rout notice C 2011010120110101 N GV001007Attending physician not employed or paid under arrangement by the patient's Attending phys not hospice 4175-5 D 2002010120020101 N GV002008hospice provider GW001007Service not related to the hospice patient's terminal condition Service unrelated to term co 4175-5 D 2002010120020101 N GX001007Notice of liability issued, voluntary under payer policy Voluntary liability notice C 2010040120100401 N GY001007Item or service statutorily excluded, does not meet the definition of any Statutorily excluded S 2002010120070701 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 2002010120020101 N H9001007Court-ordered Court-ordered I 2003010120030101 N HA001007Child/adolescent program Child/adolescent program I 2003010120030101 N HB001007Adult program, non geriatric Adult program non-geriatric I 2003010120030101 N HC001007Adult program, geriatric Adult program geriatric I 2003010120030101 N HD001007Pregnant/parenting women's program Pregnant/parenting program I 2003010120030101 N HE001007Mental health program Mental health program I 2003010120030101 N HF001007Substance abuse program Substance abuse program I 2003010120030101 N HG001007Opioid addiction treatment program Opioid addiction tx program I 2003010120030101 N HH001007Integrated mental health/substance abuse program Mental hlth/substance abs pr I 2003010120030101 N HI001007Integrated mental health and intellectual disability/developmental disabilities Men hlth intel/dev disab pgm I 2003010120140101 N HI002008program HJ001007Employee assistance program Employee assistance program I 2003010120030101 N HK001007Specialized mental health programs for high-risk populations Spec hgh rsk mntl hlth pop p I 2003010120030101 N HL001007Intern Intern I 2003010120030101 N HM001007Less than bachelor degree level Less than bachelor degree lv I 2003010120030101 N HN001007Bachelors degree level Bachelors degree level I 2003010120030101 N HO001007Masters degree level Masters degree level I 2003010120030101 N HP001007Doctoral level Doctoral level I 2003010120030101 N HQ001007Group setting Group setting I 2003010120030101 N HR001007Family/couple with client present Family/couple w client prsnt I 2003010120030101 N HS001007Family/couple without client present Family/couple w/o client prs I 2003010120030101 N HT001007Multi-disciplinary team Multi-disciplinary team I 2003010120030101 N HU001007Funded by child welfare agency Child welfare agency funded I 2003010120030101 N HV001007Funded state addictions agency Funded state addiction agncy I 2003010120030101 N HW001007Funded by state mental health agency State mntl hlth agncy funded I 2003010120030101 N HX001007Funded by county/local agency County/local agency funded I 2003010120030101 N HY001007Funded by juvenile justice agency Funded by juvenile justice I 2003010120030101 N HZ001007Funded by criminal justice agency Criminal justice agncy fund I 2003010120030101 N J1001007Competitive acquisition program no-pay submission for a prescription number Cap no-pay for prescript num C 2006010120060101 N J2001007Competitive acquisition program, restocking of emergency drugs after emergency Cap restock of emerg drugs C 2006010120060101 N J2002008administration J3001007Competitive acquisition program (cap), drug not available through cap as Cap drug unavail thru cap C 2006010120060101 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 2010010120100101 N J4002008a hospital upon discharge JA001007Administered intravenously Administered intravenously C 2007010120070101 N JB001007Administered subcutaneously Administered subcutaneously C 2007010120070101 N JC001007Skin substitute used as a graft Skin substitute graft C 2009010120090101 N JD001007Skin substitute not used as a graft Skin sub not used as a graft C 2009010120090101 N JE001007Administered via dialysate Administered via dialysate C 2013070120130701 N JF001007Compounded drug Compounded drug C 201504012015070120150630N JG001007Drug or biological acquired with 340b drug pricing program discount 340b acquired drug C 2018010120180101 N JW001007Drug amount discarded/not administered to any patient Discarded drug not administe C 2003010120030101 N K0001007Lower extremity prosthesis functional level 0 - does not have the ability or Lwr ext prost functnl lvl 0 C 1993010120030101 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 1993010119970101 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 1993010119970101 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 1993010119970101 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 1993010119970101 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 1994010119970101 N KB001007Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim>4 modifiers on claim C 2003010120030101 N KC001007Replacement of special power wheelchair interface Repl special pwr wc intrface C 2005010120050101 N KD001007Drug or biological infused through dme Drug/biological dme infused C 2004010120040101 N KE001007Bid under round one of the dmepos competitive bidding program for use with Bid under round 1 dmepos cb C 2009010120090101 N KE002008non-competitive bid base equipment KF001007Item designated by fda as class iii device Fda class iii device C 2004040120040401 N KG001007Dmepos item subject to dmepos competitive bidding program number 1 Dmepos comp bid prgm no 1 C 2007070120070701 N KH001007Dmepos item, initial claim, purchase or first month rental Dmepos ini clm, pur/1 mo rnt C 1994010119970101 N KI001007Dmepos item, second or third month rental Dmepos 2nd or 3rd mo rental C 1994010119970101 N KJ001007Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months Dmepos pen pmp or 4-15mo rnt C 1994010119970101 N KJ002008four to fifteen KK001007Dmepos item subject to dmepos competitive bidding program number 2 Dmepos comp bid prgm no 2 C 2007070120070701 N KL001007Dmepos item delivered via mail Dmepos mailorder comp bid C 2007070120090101 N KM001007Replacement of facial prosthesis including new impression/moulage Rplc facial prosth new imp C 1996010120010101 N KN001007Replacement of facial prosthesis using previous master model Rplc facial prosth old mod C 1996010120010101 N KO001007Single drug unit dose formulation Single drug unit dose form C 1997040119970401 N KP001007First drug of a multiple drug unit dose formulation First drug of multi drug u d C 1997040119970401 N KQ001007Second or subsequent drug of a multiple drug unit dose formulation 2nd/subsqnt drg multi drg ud C 1997040119970401 N KR001007Rental item, billing for partial month Rental item partial month C 2002010120020101 N KS001007Glucose monitor supply for diabetic beneficiary not treated with insulin Glucose monitor supply D 0074 1998100119981001 N KT001007Beneficiary resides in a competitive bidding area and travels outside that Item from noncontract supply C 2007070120080401 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 2007070120070701 N KV001007Dmepos item subject to dmepos competitive bidding program that is furnished as Dmepos item, profession serv C 2008010120080101 N KV002008part of a professional service KW001007Dmepos item subject to dmepos competitive bidding program number 4 Dmepos comp bid prgm no 4 C 2008010120080101 N KX001007Requirements specified in the medical policy have been met Documentation on file C 2002070120020701 N KY001007Dmepos item subject to dmepos competitive bidding program number 5 Dmepos comp bid prgm no 5 C 2008010120080101 N KZ001007New coverage not implemented by managed care New cov not implement by m+c C 2003100120031001 N L1001007Provider attestation that the hospital laboratory test(s) is not packaged under Separately payable lab test C 201407012017010120161231N L1002008the hospital opps LC001007Left circumflex coronary artery Lft circum coronary artery C 1997010119970101 N LD001007Left anterior descending coronary artery Left ant des coronary artery C 1997010119970101 N LL001007Lease/rental (use the 'll' modifier when dme equipment rental is to be applied Lease/rental (appld to pur) C 1984010119970101 N LL002008against the purchase price) LM001007Left main coronary artery Left main coronary artery C 2013010120130101 N LR001007Laboratory round trip Laboratory round trip C 1987010119970101 N LS001007Fda-monitored intraocular lens implant Fda-monitored iol implant 65-7 D 1991010119970101 N LT001007Left side (used to identify procedures performed on the left side of the body) Left side C 1984010119970101 N M2001007Medicare secondary payer (msp) Medicare secondary payer C 2007010120070101 N MS001007Six month maintenance and servicing fee for reasonable and necessary parts and 6-mo maint/svc fee parts/lbr C 1989010119970101 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 2011010120110101 N NR001007New when rented (use the 'nr' modifier when dme which was new at the time of New when rented C 1984010119970101 N NR002008rental is subsequently purchased) NU001007New equipment New equipment C 1984010119970101 N P1001007A normal healthy patient Normal healthy patient C 2006010120060101 N P2001007A patient with mild systemic disease Patient w/mild syst disease C 2006010120060101 N P3001007A patient with severe systemic disease Patient w/severe sys disease C 2006010120060101 N P4001007A patient with severe systemic disease that is a constant threat to life Pt w/sev sys dis threat life C 2006010120060101 N P5001007A moribund patient who is not expected to survive without the operation Pt not expect surv w/o oper C 2006010120060101 N P6001007A declared brain-dead patient whose organs are being removed for donor purposes Brain-dead pt organs removed C 2006010120060101 N PA001007Surgical or other invasive procedure on wrong body part Surgery, wrong body part I 2009070120090701 N PB001007Surgical or other invasive procedure on wrong patient Surgery, wrong patient I 2009070120090701 N PC001007Wrong surgery or other invasive procedure on patient Wrong surgery on patient I 2009070120090701 N PD001007Diagnostic or related non diagnostic item or service provided in a wholly owned Inp admit w/in 3 days C 2012010120120101 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 2009070120090701 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 1989010119970101 N PM001007Post mortem Post mortem C 2014010120140101 N PN001007Non-excepted service provided at an off-campus, outpatient, provider-based Non-excepted off-campus svc C 0207 2017010120170101 N PN002008department of a hospital PO001007Excepted service provided at an off-campus, outpatient, provider-based Excepted off-campus service C 0207 2015010120170101 N PO002008department of a hospital PS001007Positron emission tomography (pet) or pet/computed tomography (ct) to inform Pet tumor subsq tx strategy C 2009070120090701 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 2011010120110101 N PT002008procedure Q0001007Investigational clinical service provided in a clinical research study that is Invest clinical research D 0146 2008010120080101 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 2008010120080101 N Q1002008approved clinical research study Q2001007Demonstration procedure/service Demo procedure, service C 0046 1992010120170101 N Q3001007Live kidney donor surgery and related services Live donor surgery/services C 1995010120030101 N Q4001007Service for ordering/referring physician qualifies as a service exemption Svc exempt - ordrg/rfrng md C 1994010119970101 N Q5001007Service furnished under a reciprocal billing arrangement by a substitute Recip bill arr subs md or pt 3060.6 D 1993010120170701 N Q5002008physician or by a substitute physical therapist furnishing outpatient physical Q5003008therapy services in a health professional shortage area, a medically Q5004008underserved area, or a rural area Q6001007Service furnished under a fee-for-time compensation arrangement by a substitute Fee/time comp subst md or pt 3060.7 D 1993010120170701 N Q6002008physician or by a substitute physical therapist furnishing outpatient physical Q6003008therapy services in a health professional shortage area, a medically Q6004008underserved area, or a rural area Q7001007One class a finding One class a finding C 1995010119970101 N Q8001007Two class b findings Two class b findings C 1995010119970101 N Q9001007One class b and two class c findings 1 class b & 2 class c fndngs C 1995010119970101 N QA001007Prescribed amounts of stationary oxygen for daytime use while at rest and Avg sta day/night o2 < 1 lpm C 2018040120180401 A QA002008nighttime use differ and the average of the two amounts is less than 1 liter QA003008per minute (lpm) QB001007Prescribed amounts of stationary oxygen for daytime use while at rest and Avg day/nite o2 > 4 lpm/port C 2018040120180401 A QB002008nighttime use differ and the average of the two amounts exceeds 4 liters per QB003008minute (lpm) and portable oxygen is prescribed QC001007Single channel monitoring Single channel monitoring C 1989010119970101 N QD001007Recording and storage in solid state memory by a digital recorder Rcrdg/strg in sld st memory C 1989010119970101 N QE001007Prescribed amount of stationary oxygen while at rest is less than 1 liter per Stationary o2 @ rest <1 lpm C 1989010120180401 C QE002008minute (lpm) QF001007Prescribed amount of stationary oxygen while at rest exceeds 4 liters per Station o2 @ rest >4lpm/port C 1989010120180401 C QF002008minute (lpm) and portable oxygen is prescribed QG001007Prescribed amount of stationary oxygen while at rest is greater than 4 liters Station o2 @ rest > 4 lpm C 1989010120180401 C QG002008per minute (lpm) QH001007Oxygen conserving device is being used with an oxygen delivery system Oxygen cnsrvg dvc w del sys C 1989010119970101 N QJ001007Services/items provided to a prisoner or patient in state or local custody, Patient in state/locl custod D 0111 2003010120030101 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 1995010120010101 N QK002008involving qualified individuals QL001007Patient pronounced dead after ambulance called Patient died after amb call C 1999010119990101 N QM001007Ambulance service provided under arrangement by a provider of services Ambulance arr by provider C 1996010119990101 N QN001007Ambulance service furnished directly by a provider of services Ambulance furn by provider C 1996010119990101 N QP001007Documentation is on file showing that the laboratory test(s) was ordered Individually ordered lab tst 7517.1 D 1996010119960301 N QP002008individually or ordered as a cpt-recognized panel other than automated profile QP003008codes 80002-80019, g0058, g0059, and g0060. QQ001007Ordering professional consulted a qualified clinical decision support mechanism Qualified cdsm consulted C 2018070120180701 A QQ002008for this service and the related data was provided to the furnishing QQ003008professional QR001007Prescribed amounts of stationary oxygen for daytime use while at rest and Avg sta day/night o2 > 4 lpm C 2018040120180401 A QR002008nighttime use differ and the average of the two amounts is greater than 4 QR003008liters per minute (lpm) QS001007Monitored anesthesia care service Monitored anesthesia care 15018I D 1990010119960701 N QT001007Recording and storage on tape by an analog tape recorder Rcrdg/strg tape analog recdr C 1989010119970101 N QW001007Clia waived test Clia waived test C 1996010119961001 N QX001007Crna service: with medical direction by a physician Crna svc w/ md med direction C 1993010119970101 N QY001007Medical direction of one certified registered nurse anesthetist (crna) by an Medically directed crna 3350.5 D 1998010120010101 N QY002008anesthesiologist QZ001007Crna service: without medical direction by a physician Crna svc w/o med dir by md C 1993010119970101 N RA001007Replacement of a dme, orthotic or prosthetic item Replacement of dme item C 2009010120110101 N RB001007Replacement of a part of a dme, orthotic or prosthetic item furnished as part Replacement part, dme item C 2009010120110101 N RB002008of a repair RC001007Right coronary artery Right coronary artery C 1997010119970101 N RD001007Drug provided to beneficiary, but not administered "incident-to" Drug admin not incident-to C 2004010120040101 N RE001007Furnished in full compliance with fda-mandated risk evaluation and mitigation Furnish full compliance rems C 2009010120090101 N RE002008strategy (rems) RI001007Ramus intermedius coronary artery Ramus intermedius cor artery C 2013010120130101 N RR001007Rental (use the 'rr' modifier when dme is to be rented) Rental (dme) C 1984010119970101 N RT001007Right side (used to identify procedures performed on the right side of the body)Right side C 1984010119970101 N SA001007Nurse practitioner rendering service in collaboration with a physician Nurse practitioner w physici I 2001070120010701 N SB001007Nurse midwife Nurse midwife I 2001070120010701 N SC001007Medically necessary service or supply Medically necessary serv/sup C 2001070120110401 N SD001007Services provided by registered nurse with specialized, highly technical home Serv by home infusion rn I 2001070120010701 N SD002008infusion training SE001007State and/or federally-funded programs/services State/fed funded program/ser I 2001070120010701 N SF001007Second opinion ordered by a professional review organization (pro) per section 2nd opinion ordered by pro C 1987010119970101 N SF0020089401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance) SG001007Ambulatory surgical center (asc) facility service Asc facility service C 1992010119970101 N SH001007Second concurrently administered infusion therapy 2nd concurrent infusion ther I 2001070120010701 N SJ001007Third or more concurrently administered infusion therapy 3rd concurrent infusion ther I 2001070120010701 N SK001007Member of high risk population (use only with codes for immunization) High risk population I 2002040120020401 N SL001007State supplied vaccine State supplied vaccine I 2002040120020401 N SM001007Second surgical opinion Second opinion I 2002070120020701 N SN001007Third surgical opinion Third opinion I 2002070120020701 N SQ001007Item ordered by home health Item ordered by home health I 2002100120021001 N SS001007Home infusion services provided in the infusion suite of the iv therapy providerHit in infusion suite I 2004100120041001 N ST001007Related to trauma or injury Related to trauma or injury I 2003010120030101 N SU001007Procedure performed in physician's office (to denote use of facility and Performed in phys office I 2003010120030101 N SU002008equipment) SV001007Pharmaceuticals delivered to patient's home but not utilized Drugs delivered not used I 2003010120030101 N SW001007Services provided by a certified diabetic educator Serv by cert diab educator C 2004040120040401 N SY001007Persons who are in close contact with member of high-risk population (use only Contact w/high-risk pop I 2005010120050101 N SY002008with codes for immunization) SZ001007Habilitative services Habilitative services C 201407012018010120171231N T1001007Left foot, second digit Left foot, second digit C 1995010119990101 N T2001007Left foot, third digit Left foot, third digit C 1995010119990101 N T3001007Left foot, fourth digit Left foot, fourth digit C 1995010119990101 N T4001007Left foot, fifth digit Left foot, fifth digit C 1995010119990101 N T5001007Right foot, great toe Right foot, great toe C 1995010119990101 N T6001007Right foot, second digit Right foot, second digit C 1995010119990101 N T7001007Right foot, third digit Right foot, third digit C 1995010119990101 N T8001007Right foot, fourth digit Right foot, fourth digit C 1995010119990101 N T9001007Right foot, fifth digit Right foot, fifth digit C 1995010119990101 N TA001007Left foot, great toe Left foot, great toe C 1995010119990101 N TB001007Drug or biological acquired with 340b drug pricing program discount, reported Tracking 340b acquired drug C 2018010120180101 N TB002008for informational purposes TC001007Technical component; under certain circumstances, a charge may be made for the Technical component C 1984010119970101 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 2001070120010701 N TE001007Lpn/lvn Lpn/lvn I 2001070120010701 N TF001007Intermediate level of care Intermediate level of care I 2001070120010701 N TG001007Complex/high tech level of care Complex/high tech level care I 2001070120010701 N TH001007Obstetrical treatment/services, prenatal or postpartum Ob tx/srvcs prenatl/postpart I 2001070120010701 N TJ001007Program group, child and/or adolescent Child/adolescent program gp I 2001070120010701 N TK001007Extra patient or passenger, non-ambulance Extra patient or passenger I 2002040120020401 N TL001007Early intervention/individualized family service plan (ifsp) Early intervention ifsp I 2002040120020401 N TM001007Individualized education program (iep) Individualized ed prgrm(iep) I 2002040120020401 N TN001007Rural/outside providers' customary service area Rural/out of service area I 2002040120020401 N TP001007Medical transport, unloaded vehicle Med transprt unloaded vehicl I 2002040120020401 N TQ001007Basic life support transport by a volunteer ambulance provider Bls by volunteer amb providr I 2002040120020401 N TR001007School-based individualized education program (iep) services provided outside School-based iep out of dist I 2002070120020701 N TR002008the public school district responsible for the student TS001007Follow-up service Follow-up service C 2002100120060101 N TT001007Individualized service provided to more than one patient in same setting Additional patient I 2002100120021001 N TU001007Special payment rate, overtime Overtime payment rate I 2003010120030101 N TV001007Special payment rates, holidays/weekends Holiday/weekend payment rate I 2003010120030101 N TW001007Back-up equipment Back-up equipment I 2003010120030101 N U1001007Medicaid level of care 1, as defined by each state M/caid care lev 1 state def I 2002070120020701 N U2001007Medicaid level of care 2, as defined by each state M/caid care lev 2 state def I 2002070120020701 N U3001007Medicaid level of care 3, as defined by each state M/caid care lev 3 state def I 2002070120020701 N U4001007Medicaid level of care 4, as defined by each state M/caid care lev 4 state def I 2002070120020701 N U5001007Medicaid level of care 5, as defined by each state M/caid care lev 5 state def I 2002070120020701 N U6001007Medicaid level of care 6, as defined by each state M/caid care lev 6 state def I 2002070120020701 N U7001007Medicaid level of care 7, as defined by each state M/caid care lev 7 state def I 2002070120020701 N U8001007Medicaid level of care 8, as defined by each state M/caid care lev 8 state def I 2002070120020701 N U9001007Medicaid level of care 9, as defined by each state M/caid care lev 9 state def I 2002070120020701 N UA001007Medicaid level of care 10, as defined by each state M/caid care lev 10 state def I 2002070120020701 N UB001007Medicaid level of care 11, as defined by each state M/caid care lev 11 state def I 2002070120020701 N UC001007Medicaid level of care 12, as defined by each state M/caid care lev 12 state def I 2002070120020701 N UD001007Medicaid level of care 13, as defined by each state M/caid care lev 13 state def I 2002070120020701 N UE001007Used durable medical equipment Used durable med equipment C 1984010119970101 N UF001007Services provided in the morning Services provided, morning I 2003040120030401 N UG001007Services provided in the afternoon Services provided, afternoon I 2003040120030401 N UH001007Services provided in the evening Services provided, evening I 2003040120030401 N UJ001007Services provided at night Services provided, night C 2003040120170101 N UK001007Services provided on behalf of the client to someone other than the client Svc on behalf client-collat I 2003040120030401 N UK002008(collateral relationship) UN001007Two patients served Two patients served C 0114 2004010120040101 N UP001007Three patients served Three patients served C 0114 2004010120040101 N UQ001007Four patients served Four patients served C 0114 2004010120040101 N UR001007Five patients served Five patients served C 0114 2004010120040101 N US001007Six or more patients served Six or more patients served C 0114 2004010120040101 N V1001007Demonstration modifier 1 Demonstration modifier 1 C 2017010120170101 N V2001007Demonstration modifier 2 Demonstration modifier 2 C 2017010120170101 N V3001007Demonstration modifier 3 Demonstration modifier 3 C 2017010120170101 N V5001007Vascular catheter (alone or with any other vascular access) Vascular catheter C 2010010120100701 N V6001007Arteriovenous graft (or other vascular access not including a vascular catheter)Arteriovenous graft C 2010010120100701 N V7001007Arteriovenous fistula only (in use with two needles) Arteriovenous fistula C 2010010120100701 N V8001007Infection present Infection present C 201001012012040120120331N V9001007No infection present No infection present C 201001012012040120120331N VM001007Medicare diabetes prevention program (mdpp) virtual make-up session Mdpp virtual make-up session C 2018040120180401 A VP001007Aphakic patient Aphakic patient C 1984010119970101 N X1001007Continuous/broad services: for reporting services by clinicians, who provide Continuous/broad services C 2018010120180101 N X1002008the principal care for a patient, with no planned endpoint of the relationship; X1003008services in this category represent comprehensive care, dealing with the entire X1004008scope of patient problems, either directly or in a care coordination role; X1005008reporting clinician service examples include, but are not limited to: primary X1006008care, and clinicians providing comprehensive care to patients in addition to X1007008specialty care X2001007Continuous/focused services: for reporting services by clinicians whose Continuous/focused services C 2018010120180101 N X2002008expertise is needed for the ongoing management of a chronic disease or a X2003008condition that needs to be managed and followed with no planned endpoint to the X2004008relationship; reporting clinician service examples include but are not limited X2005008to: a rheumatologist taking care of the patient's rheumatoid arthritis X2006008longitudinally but not providing general primary care services X3001007Episodic/broad servies: for reporting services by clinicians who have broad Episodic/broad services C 2018010120180101 N X3002008responsibility for the comprehensive needs of the patient that is limited to a X3003008defined period and circumstance such as a hospitalization; reporting clinician X3004008service examples include but are not limited to the hospitalist's services X3005008rendered providing comprehensive and general care to a patient while admitted X3006008to the hospital X4001007Episodic/focused services: for reporting services by clinicians who provide Episodic/focused services C 2018010120180101 N X4002008focused care on particular types of treatment limited to a defined period and X4003008circumstance; the patient has a problem, acute or chronic, that will be treated X4004008with surgery, radiation, or some other type of generally time-limited X4005008intervention; reporting clinician service examples include but are not limited X4006008to, the orthopedic surgeon performing a knee replacement and seeing the patient X4007008through the postoperative period X5001007Diagnostic services requested by another clinician: for reporting services by a Svc req by another clinician C 2018010120180101 N X5002008clinician who furnishes care to the patient only as requested by another X5003008clinician or subsequent and related services requested by another clinician; X5004008this modifier is reported for patient relationships that may not be adequately X5005008captured by the above alternative categories; reporting clinician service X5006008examples include but are not limited to, the radiologist's interpretation of an X5007008imaging study requested by another clinician XE001007Separate encounter, a service that is distinct because it occurred during a Separate encounter C 2015010120150101 N XE002008separate encounter XP001007Separate practitioner, a service that is distinct because it was performed by a Separate practitioner C 2015010120150101 N XP002008different practitioner XS001007Separate structure, a service that is distinct because it was performed on a Separate organ/structure C 2015010120150101 N XS002008separate organ/structure XU001007Unusual non-overlapping service, the use of a service that is distinct because Unusual separate service C 2015010120150101 N XU002008it does not overlap usual components of the main service ZA001007Novartis/sandoz Novartis/sandoz C 201601012018040120180331D ZB001007Pfizer/hospira Pfizer/hospira C 201607012018040120180331D ZC001007Merck/samsung bioepis Merck/samsung bioepis C 201710012018040120180331D 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: wheelchair van Noner transport wheelch van 00 9 I O1A D 01982010119820101 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 01982010119820101 N A0190001003Non-emergency transportation: ancillary: meals-recipient Noner transport meals recip 00 9 I O1A D 01984010119840101 N A0200001003Non-emergency transportation: ancillary: lodging escort Noner transport lodgng escrt00 9 I O1A D 01982010119820101 N A0210001003Non-emergency transportation: ancillary: meals-escort Noner transport meals escort00 9 I O1A D 01984010119840101 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 suppls00 9 I O1A D 01995010120140101 N A0384001003Bls specialized service disposable supplies; defibrillation (used by als Bls defibrillation supplies 00 9 I O1A D 01995010120140101 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 00 9 I O1A D 01995010120140101 N A0392002004jurisdictions where defibrillation cannot be performed in bls ambulances) A0394001003Als specialized service disposable supplies; iv drug therapy Als iv drug therapy supplies00 9 I O1A D 01995010120140101 N A0396001003Als specialized service disposable supplies; esophageal intubation Als esophageal intub suppls 00 9 I O1A D 01995010120140101 N A0398001003Als routine disposable supplies Als routine disposble suppls00 9 I O1A D 01995010120140101 N A0420001003Ambulance waiting time (als or bls), one half (1/2) hour increments Ambulance waiting 1/2 hr 00 9 I O1A D 01995010120140101 N A0422001003Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation Ambulance 02 life sustaining00 9 I O1A D 01995010120140101 N A0424001003Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); Extra ambulance attendant 00 9 I O1A D 01995010120140101 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 (als 1 - Als1-emergency 52 A C O1A D 02001010120010101 N A0427002004emergency) 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 closest Noncovered ambulance mileage00 9 2125 M O1A D 01995010119950101 N A0888002004appropriate 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 2 cc, each 2 cc sterile syringe&needle 00 9 C D1A S 01985010120070101 N A4208001003Syringe with needle, sterile 3 cc, each 3 cc sterile syringe&needle 00 9 C D1A S 01985010120070101 N A4209001003Syringe with needle, sterile 5 cc 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 non-insulin drug infusion catheter, per week (list Supp non-insulin inf cath/wk34 A C D1E P 01997010120170101 N A4221002004drugs separately) 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) A4224001003Supplies for maintenance of insulin infusion catheter, per week Supply insulin inf cath/wk 34 A C D1E P 02017010120170101 N A4225001003Supplies for external insulin infusion pump, syringe type cartridge, sterile, Sup/ext insulin inf pump syr34 A 60-14 D D1E P 02017010120170101 N A4225002004each 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, 3 cc 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 mon32 A C D1E P 02006010120160101 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 32 A C D1E P 02006010120160101 N A4234002004blood glucose monitor owned by patient, each A4235001003Replacement battery, lithium, for use with medically necessary home blood Lithium batt for glucose mon32 A C D1E P 02006010120160101 N A4235002004glucose monitor owned by patient, each A4236001003Replacement battery, silver oxide, for use with medically necessary home blood Silvr oxide batt glucose mon32 A C D1E P 02006010120160101 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 00 9 C P9B L 02004010120150101 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 01994010119960101 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 A4300001003Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or Cath impl vasc access portal11 A 2130 D Y1 S 01986010120020101 N A4300002004peritoneal, 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 A4310001003Insertion 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 A4337001003Incontinence supply, rectal insert, any type, each Incontinent rectal insert 38 A 2130 D D1F P 02016010120160101 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, (e.g., 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 A4356001003External 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 A4356002004clamp), 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 A4358001003Urinary 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 A4358002004each A4360001003Disposable external urethral clamp or compression device, with pad and/or Disposable ext urethral dev 37 A D 0124D1F 9 02010010120100101 N A4360002004pouch, each A4361001003Ostomy 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 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 4 x 4 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 accordion), 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 4 x 4 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 fluid Ostomy pouch liq deodorant 37 A 2130 D D1F P 02000010120070101 N A4394002004ounce 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, with 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 4 x 4 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 4 x 4 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 46 A C D1F P 01985010120180101 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 N 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 A4459001003Manual pump-operated enema system, includes balloon, catheter and all Manual pump enema, reusable 00 9 C Z2 9 02015010120150101 N A4459002004accessories, reusable, any type 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 A4467 M 0196Z2 9 0201001012017010120161231N A4466002004material, any type, each A4467001003Belt, strap, sleeve, garment, or covering, any type Belt strap sleev grmnt cover00 9 M 0208Z2 9 02017010120170101 N 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 A4553001003Non-disposable underpads, all sizes Nondisp underpads, all sizes00 960-9 M D1A 9 02017010120170101 N A4554001003Disposable underpads, all sizes Disposable underpads 00 960-9 M D1A 9 01986010120050101 N A4555001003Electrode/transducer for use with electrical stimulation device used for cancer Ca tx e-stim electr/transduc00 9 I D1E P 02014010120140101 N A4555002004treatment, replacement only 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), per Conductive gel or paste 34 A C D1E P 01985010120070101 N A4558002004oz 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 A4563001003Rectal control system for vaginal insertion, for long term use, includes pump Vag inser rectal control sys38 A C D1F P 02019010120190101 A A4563002004and all supplies and accessories, any type each A4565001003Slings Slings 55 A C D1A P 01983010120141001 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 9 C 0170D1A 9 01996010120171001 N A4580001003Cast supplies (e.g., plaster) Cast supplies (plaster) 00 9 2079 I D1A 9 01982010119820101 N A4590001003Special casting material (e.g., fiberglass) Special casting material 00 9 2079 I D1A 9 01984010119840101 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, rechargeable, for non-prosthetic use, replacement Lith ion non prosth recharge32 A C D1E P 02007010120150101 N A4602001003Replacement battery for external infusion pump owned by patient, lithium, 1.5 Replace lithium battery 1.5v32 A C D1E P 02015010120150101 N A4602002004volt, each 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 D1C P 02001010120140101 N A4611001003Battery, heavy duty; replacement for patient owned ventilator Heavy duty battery 00 9 1834a3A S D1E P 01990010120140101 N A4612001003Battery cables; replacement for patient-owned ventilator Battery cables 00 9 1834a3A S D1E P 01990010120140101 N A4613001003Battery charger; replacement for patient-owned ventilator Battery charger 00 9 1834a3A S D1E P 01990010120140101 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 A4630001003Replacement batteries, medically necessary, transcutaneous electrical Repl bat t.e.n.s. own by pt 32 A65-8 D D1E APR 01991010120060101 N A4630002004stimulator, 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 01991010119910101 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 pad36 A C D1E APR 02003010120140401 N A4640001003Replacement pad for use with medically necessary alternating pressure pad owned Alternating pressure pad 32 A60-9 4107.6 D D1E APR 01991010119910101 N A4640002004by patient A4641001003Radiopharmaceutical, 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 A4650001003Implantable radiation dosimeter, each Implant radiation dosimeter 57 A C I1E 9S 02008010120080101 N A4651001003Calibrated microcapillary tube, each Calibrated microcap tube 00 9 4270 D 0017P9B L 02002010120150101 N A4652001003Microcapillary tube sealant Microcapillary tube sealant 00 9 4270 D 0017P9B L 02002010120150101 N A4653001003Peritoneal dialysis catheter anchoring device, belt, each Pd catheter anchor belt 00 9 C P9B L 02003010120150101 N A4657001003Syringe, with or without needle, each Syringe w/wo needle 00 9 4270 D 0017P9B L 02002010120150101 N A4660001003Sphygmomanometer/blood pressure apparatus with cuff and stethoscope Sphyg/bp app w cuff and stet00 9 4270 D 0017P9B L 01986010120150101 N A4663001003Blood pressure cuff only Dialysis blood pressure cuff00 9 4270 D 0017P9B L 01986010120150101 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 00 9 4270 D P9B L 02004010120150101 N A4672001003Drainage extension line, sterile, for dialysis, each Drainage ext line, dialysis 00 9 4270 D P9B L 02004010120150101 N A4673001003Extension line with easy lock connectors, used with dialysis Ext line w easy lock connect00 9 4270 D P9B L 02004010120150101 N A4674001003Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per Chem/antisept solution, 8oz 00 9 4270 D P9B L 02004010120150101 N A46740020048 oz A4680001003Activated carbon filter for hemodialysis, each Activated carbon filter, ea 00 955-1 4270 D 0017P9B L 01986010120150101 N A4690001003Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each Dialyzer, each 00 9 4270 D 0017P9B L 01986010120150101 N A4706001003Bicarbonate concentrate, solution, for hemodialysis, per gallon Bicarbonate conc sol per gal00 9 4270 D 0017P9B L 02002010120150101 N A4707001003Bicarbonate concentrate, powder, for hemodialysis, per packet Bicarbonate conc pow per pac00 9 4270 D 0017P9B L 02002010120150101 N A4708001003Acetate concentrate solution, for hemodialysis, per gallon Acetate conc sol per gallon 00 9 4270 D 0017P9B L 02002010120150101 N A4709001003Acid concentrate, solution, for hemodialysis, per gallon Acid conc sol per gallon 00 9 4270 D 0017P9B L 02002010120150101 N A4714001003Treated water (deionized, distilled, or reverse osmosis) for peritoneal Treated water per gallon 00 955-1 4270 D 0017P9B L 01986010120150101 N A4714002004dialysis, per gallon A4719001003"y set" tubing for peritoneal dialysis "y set" tubing 00 9 4270 D 0017P9B L 02002010120150101 N A4720001003Dialysate solution, any concentration of dextrose, fluid volume greater than Dialysat sol fld vol > 249cc00 9 4270 D 0017P9B L 02002010120150101 N A4720002004249 cc, but less than or equal to 999 cc, for peritoneal dialysis A4721001003Dialysate solution, any concentration of dextrose, fluid volume greater than Dialysat sol fld vol > 999cc00 9 4270 D 0017P9B L 02002010120150101 N A4721002004999 cc but less than or equal to 1999 cc, for peritoneal dialysis A4722001003Dialysate solution, any concentration of dextrose, fluid volume greater than Dialys sol fld vol > 1999cc 00 9 4270 D 0017P9B L 02002010120150101 N A47220020041999 cc but less than or equal to 2999 cc, for peritoneal dialysis A4723001003Dialysate solution, any concentration of dextrose, fluid volume greater than Dialys sol fld vol > 2999cc 00 9 4270 D 0017P9B L 02002010120150101 N A47230020042999 cc but less than or equal to 3999 cc, for peritoneal dialysis A4724001003Dialysate solution, any concentration of dextrose, fluid volume greater than Dialys sol fld vol > 3999cc 00 9 4270 D 0017P9B L 02002010120150101 N A47240020043999 cc but less than or equal to 4999 cc, for peritoneal dialysis A4725001003Dialysate solution, any concentration of dextrose, fluid volume greater than Dialys sol fld vol > 4999cc 00 9 4270 D 0017P9B L 02002010120150101 N A47250020044999 cc but less than or equal to 5999 cc, for peritoneal dialysis A4726001003Dialysate solution, any concentration of dextrose, fluid volume greater than Dialys sol fld vol > 5999cc 00 9 4270 D 0017P9B L 02002010120150101 N A47260020045999 cc, for peritoneal dialysis A4728001003Dialysate solution, non-dextrose containing, 500 ml Dialysate solution, non-dex 00 9 C P9B L 02004010120150101 N A4730001003Fistula cannulation set for hemodialysis, each Fistula cannulation set, ea 00 9 4270 D 0017P9B L 01986010120150101 N A4736001003Topical anesthetic, for dialysis, per gram Topical anesthetic, per gram00 9 4270 D 0017P9B L 02002010120150101 N A4737001003Injectable anesthetic, for dialysis, per 10 ml Inj anesthetic per 10 ml 00 9 4270 D 0017P9B L 02002010120150101 N A4740001003Shunt accessory, for hemodialysis, any type, each Shunt accessory 00 9 4270 D 0017P9B L 01986010120150101 N A4750001003Blood tubing, arterial or venous, for hemodialysis, each Art or venous blood tubing 00 9 4270 D 0017P9B L 01986010120150101 N A4755001003Blood tubing, arterial and venous combined, for hemodialysis, each Comb art/venous blood tubing00 9 4270 D 0017P9B L 01986010120150101 N A4760001003Dialysate solution test kit, for peritoneal dialysis, any type, each Dialysate sol test kit, each00 9 4270 D 0017P9B L 01986010120150101 N A4765001003Dialysate concentrate, powder, additive for peritoneal dialysis, per packet Dialysate conc pow per pack 00 9 4270 D 0017P9B L 01986010120150101 N A4766001003Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml Dialysate conc sol add 10 ml00 9 4270 D 0017P9B L 02002010120150101 N A4770001003Blood collection tube, vacuum, for dialysis, per 50 Blood collection tube/vacuum00 9 4270 D 0017P9B L 01986010120150101 N A4771001003Serum clotting time tube, for dialysis, per 50 Serum clotting time tube 00 9 4270 D 0017P9B L 01986010120150101 N A4772001003Blood glucose test strips, for dialysis, per 50 Blood glucose test strips 00 9 4270 D 0017P9B L 01986010120150101 N A4773001003Occult blood test strips, for dialysis, per 50 Occult blood test strips 00 9 4270 D 0017P9B L 01986010120150101 N A4774001003Ammonia test strips, for dialysis, per 50 Ammonia test strips 00 9 4270 D 0017P9B L 01986010120150101 N A4802001003Protamine sulfate, for hemodialysis, per 50 mg Protamine sulfate per 50 mg 00 9 4270 D 0017P9B L 02002010120150101 N A4860001003Disposable catheter tips for peritoneal dialysis, per 10 Disposable catheter tips 00 9 4270 D 0017P9B L 01986010120150101 N A4870001003Plumbing and/or electrical work for home hemodialysis equipment Plumb/elec wk hm hemo equip 00 9 4270 D 0017P9B L 01986010120150101 N A4890001003Contracts, repair and maintenance, for hemodialysis equipment Repair/maint cont hemo equip00 9 2100.4 D 0017P9B L 01986010120150101 N A4911001003Drain bag/bottle, for dialysis, each Drain bag/bottle 00 9 D 0017P9B L 02002010120150101 N A4913001003Miscellaneous dialysis supplies, not otherwise specified Misc dialysis supplies noc 00 9 D 0017P9B L 01986010120150101 N A4918001003Venous pressure clamp, for hemodialysis, each Venous pressure clamp 00 9 D 0017P9B L 01986010120150101 N A4927001003Gloves, non-sterile, per 100 Non-sterile gloves 00 9 D 0017P9B L 01986010120150101 N A4928001003Surgical mask, per 20 Surgical mask 00 9 D 0017P9B L 02002010120150101 N A4929001003Tourniquet for dialysis, each Tourniquet for dialysis, ea 00 9 D 0017P9B L 02002010120150101 N A4930001003Gloves, sterile, per pair Sterile, gloves per pair 00 9 D 0017P9B L 02003010120150101 N A4931001003Oral thermometer, reusable, any type, each Reusable oral thermometer 00 9 C P9B L 02003010120150101 N A4932001003Rectal thermometer, reusable, any type, each Reusable rectal thermometer 00 9 C Z2 9 02003010120070101 N A5051001003Ostomy 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 A5081001003Stoma plug or seal, any type Stoma plug or seal, any type37 A 2130 D D1F P 01990010120140101 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 A5102001003Bedside 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 A5500001003For diabetics only, fitting (including follow-up), custom preparation and Diab shoe for density insert38 A 2134 D D1F J 01995010120050101 N A5500002004supply of off-the-shelf depth-inlay shoe manufactured to accommodate A5500003004multi-density 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 2134 D D1F J 02006010120190101 F 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 2134 D D1F J 020060101 B 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 A5513004004arch filler and other shaping material, custom fabricated, each A5514001003For diabetics only, multiple density insert, made by direct carving with cam Mult den insert dir carv/cam38 A 2134 D D1F J 02019010120190101 A A5514002004technology from a rectified cad model created from a digitized scan of the A5514003004patient, total contact with patient's foot, including arch, base layer minimum A5514004004of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler A5514005004and 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 N 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 N 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 N 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 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 dressing 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., without Hydrogel drg >48 in w/o bdr 35 A 2079 D D1A S 01997010120090101 N A6244002004adhesive 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 dressing 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 A6460001003Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, Synthetic drsg <= 16 sq in 35 A C D1A S 02019010120190101 A A6460002004without adhesive border, each dressing A6461001003Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but Synthetic drsg >16<=48 sq in35 A C D1A S 02019010120190101 A A6461002004less than or equal to 48 sq. in., without adhesive border, each dressing 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 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 0200001012016010120151231N 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 36 A C D1E APR 02003010120140401 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 0200301012015010120141231N A7043001003Vacuum drainage bottle and tubing for use with implanted catheter Vacuum drainagebottle/tubing38 A C D1F P 0200301012015010120141231N 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 A7047001003Oral interface used with respiratory suction pump, each Resp suction oral interface 32 A C D1E APR 02014010120140101 N A7048001003Vacuum drainage collection unit and tubing kit, including all supplies needed Vacuum drain bottle/tube kit38 A C D1F P 02015010120150101 N A7048002004for collection unit change, for use with implanted catheter, 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 A9150001003Non-prescription drugs Misc/exper non-prescript dru57 A 2050.5 D O1E 9 01986010119960101 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 A9272001003Wound suction, disposable, includes dressing, all accessories and components, Disp wound suct, drsg/access00 9 1861(n) S D1A 9 02012010120150101 N A9272002004any type, each A9273001003Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type Hot/cold botle/cap/col/wrap 00 9 M 0137Z2 APR 02011010120190101 C A9274001003External ambulatory insulin delivery system, disposable, each, includes all Ext amb insulin delivery sys00 9 1861(n) S D1A 9 02008010120150101 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 1861(n) S T2D 9 02007010120150101 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 A9285001003Inversion/eversion correction device Inversion eversion cor devic00 9 C Z2 9 02017010120170101 N A9286001003Hygienic item or device, disposable or non-disposable, any type, each Any hygienic item, device 00 9 1834 S 0209D1A 9 02017010120170101 N A9300001003Exercise equipment Exercise equipment 00 960-9 2100.1 M Z2 9 01993010119960101 N A9500001003Technetium 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 A9513001003Lutetium lu 177, dotatate, therapeutic, 1 millicurie Lutetium lu 177 dotatat ther57 A153.60 DYY20190101 I1E 6 02019010120190101 A A9515001003Choline c-11, diagnostic, per study dose up to 20 millicuries Choline c-11 57 A C I1E 4 02017010120190101 P 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 A9520001003Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries Tc99 tilmanocept diag 0.5mci57 A C I1E 4 02014010120160101 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 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 0200601012017010120161231N A9545001003Iodine i-131 tositumomab, therapeutic, per treatment dose I131 tositumomab, rx 57 A C I1E 6 0200601012017010120161231N 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 A9575001003Injection, gadoterate meglumine, 0.1 ml Inj gadoterate meglumi 0.1ml57 A C I1E 4 02014010120140101 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 C 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 DYY20181001 0189I1E 4 02013010120181001 P A9587001003Gallium ga-68, dotatate, diagnostic, 0.1 millicurie Gallium ga-68 57 A CYY20170101 I1E 4 02017010120170101 N A9588001003Fluciclovine f-18, diagnostic, 1 millicurie Fluciclovine f-18 57 A CYY20170101 I1E 4 02017010120170101 N A9589001003Instillation, hexaminolevulinate hydrochloride, 100 mg Insti hexaminolevulinate hcl57 A C I1E 4 02019010120190101 A A9597001003Positron emission tomography radiopharmaceutical, diagnostic, for tumor Pet, dx, for tumor id, noc 57 A C I1E 4 02017010120170101 N A9597002004identification, not otherwise classified A9598001003Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor Pet dx for non-tumor id, noc57 A C I1E 4 02017010120170101 N A9598002004identification, not otherwise classified A9599001003Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography Radioph dx b amyloid pet nos57 A D 0191I1E 4 0201401012018010120171231N A9599002004(pet) imaging, per study dose, not otherwise specified 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 A9606001003Radium ra-223 dichloride, therapeutic, per microcurie Radium ra223 dichloride ther57 A C I1E 4 02015010120180101 N 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 A9900001003Miscellaneous dme supply, accessory, and/or service component of another hcpcs Supply/accessory/service 46 A C D1E 9 02000010120010101 N A9900002004code 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 B4034001003Enteral 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 B4034002004feeding/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 O1C E 02008010120160101 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 B4105001003In-line cartridge containing digestive enzyme(s) for enteral feeding, each Enzyme cartridge enteral nut00 9 Q9994 D 0217O1C E 02019010120190101 A 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) - home mix B4168001003Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix 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 B4172002004home mix 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 B4176002004home mix 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- home mix 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) - home mix 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), home mix, 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 01988010120160101 N B5000002004electrolytes, trace elements, and vitamins, including preparation, any B5000003004strength, renal-aminosyn-rf, nephramine, renamine-premix B5100001003Parenteral nutrition solution compounded amino acid and carbohydrates with Parenteral solution hepatic 39 A65-10 2130 4450 D O1C E 01988010120160101 N B5100002004electrolytes, trace elements, and vitamins, including preparation, any B5100003004strength, hepatic, hepatamine-premix B5200001003Parenteral nutrition solution compounded amino acid and carbohydrates with Parenteral sol hepatic fream39 A65-10 2130 4450 D O1C E 01988010120160101 N B5200002004electrolytes, trace elements, and vitamins, including preparation, any B5200003004strength, stress-branch chain amino acids-freamine-hbc-premix B9000001003Enteral nutrition infusion pump - without alarm Enter infusion pump w/o alrm39 A65-10 2130 4450 D O1C APR 0198801012017010120161231N B9002001003Enteral nutrition infusion pump, any type Enter nutr inf pump any type39 A65-10 2130 4450 D O1C APR 01988010120170101 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 0200008012015010120141231N 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 9F 02006010120060101 N C1820002004charging system C1821001003Interspinous process distraction device (implantable) Interspinous implant 53 A 1833(T) D D1A 9 02007010120070101 N C1822001003Generator, neurostimulator (implantable), high frequency, with rechargeable Gen, neuro, hf, rechg bat 53 A 1833(T) D D1A 9F 02016010120180101 N C1822002004battery and charging system C1823001003Generator, neurostimulator (implantable), non-rechargeable, with transvenous Gen, neuro, trans sen/stim 53 A 1833(t) DYY20190101 D1A 9F 02019010120190101 A C1823002004sensing and stimulation leads C1830001003Powered bone marrow biopsy needle Power bone marrow bx needle 53 A 1833(t) D D1A 9S 02011100120140101 N C1840001003Lens, intraocular (telescopic) Telescopic intraocular lens 53 A 1833(t) D D1A 9S 02011100120140101 N C1841001003Retinal prosthesis, includes all internal and external components Retinal prosth int/ext comp 53 A 1833(t) DYY20131001 D1E 9F 02013100120131001 N C1842001003Retinal prosthesis, includes all internal and external components; add-on to Retinal prosth, add-on 53 A 1833(t) DYY20170101 D1E 9F 02017010120170101 N C1842002004c1841 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 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 C1883001003Adapter/extension, pacing lead or neurostimulator lead (implantable) Adapt/ext, pacing/neuro lead53 A 1833(T) D D1A 9S 02001040120010401 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) D D1A 9S 02012010120140101 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 C1889001003Implantable/insertable device, not otherwise classified Implant/insert device, noc 53 A 1833(T) D D1A 9F 02017010120190101 C 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 C2613001003Lung biopsy plug with delivery system Lung bx plug w/del sys 53 A 1833(t) D D1A 9F 02015070120180101 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/needle, cryoablation Probe/needle, cryo 53 A 1833(T) D D1A 9S 02001040120140101 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 C2623001003Catheter, transluminal angioplasty, drug-coated, non-laser Cath, translumin, drug-coat 53 A 1833(t) D D1A 9F 02015040120180101 N C2624001003Implantable wireless pulmonary artery pressure sensor with delivery catheter, Wireless pressure sensor 53 A 1833(t) D D1A 9F 02015010120180101 N C2624002004including all system components 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, other than intracardiac Intro/sheath, laser 53 A 1833(T) D D1A 9S 02001040120130101 N C2629002004electrophysiological, laser 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 Brachytx, non-str, ha, i-12553 A 1833(T) DYY20080101 I4B 9 02005010120070701 N C26340020041.01 mci (nist), per source C2635001003Brachytherapy source, non-stranded, high activity, palladium-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, palladium-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 C2644001003Brachytherapy source, cesium-131 chloride solution, per millicurie Brachytx cesium-131 chloride53 A 1833(t) D I4B 6F 02014070120190101 P C2645001003Brachytherapy planar source, palladium-103, per square millimeter Brachytx planar, p-103 53 A 1833(T) DYY20160101 I4B 9 02016010120160101 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 C5271001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53 A 1833(t) DYY20140101 P5A 2F 02014010120140101 N C5271002004surface area up to 100 sq cm; first 25 sq cm or less wound surface area C5272001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53 A 1833(t) D P5A 2F 02014010120140101 N C5272002004surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or C5272003004part thereof (list separately in addition to code for primary procedure) C5273001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53 A 1833(t) DYY20140101 P5A 2F 02014010120140101 N C5273002004surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface C5273003004area, or 1% of body area of infants and children C5274001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53 A 1833(t) D P5A 2F 02014010120140101 N C5274002004surface area greater than or equal to 100 sq cm; each additional 100 sq cm C5274003004wound surface area, or part thereof, or each additional 1% of body area of C5274004004infants and children, or part thereof (list separately in addition to code for C5274005004primary procedure) C5275001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth, Low cost skin substitute app53 A 1833(t) DYY20140101 P5A 2F 02014010120140101 N C5275002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound C5275003004surface area up to 100 sq cm; first 25 sq cm or less wound surface area C5276001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth, Low cost skin substitute app53 A 1833(t) D P5A 2F 02014010120140101 N C5276002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound C5276003004surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or C5276004004part thereof (list separately in addition to code for primary procedure) C5277001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth, Low cost skin substitute app53 A 1833(t) DYY20140101 P5A 2F 02014010120140101 N C5277002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound C5277003004surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface C5277004004area, or 1% of body area of infants and children C5278001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth, Low cost skin substitute app53 A 1833(t) D P5A 2F 02014010120140101 N C5278002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound C5278003004surface area greater than or equal to 100 sq cm; each additional 100 sq cm C5278004004wound surface area, or part thereof, or each additional 1% of body area of C5278005004infants and children, or part thereof (list separately in addition to code for C5278006004primary procedure) C8900001003Magnetic 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) 77046 D I2D 4 0200110012019010120181231D 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) 77047 D I2D 4 0200110012019010120181231D 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 C8937001003Computer-aided detection, including computer algorithm analysis of breast mri Cad breast mri 53 A 1833(t) 0159T D I2D 4 02019010120190101 A C8937002004image data for lesion detection/characterization, pharmacokinetic analysis, C8937003004with further physician review for interpretation (list separately in addition C8937004004to code for primary procedure) 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 C9014001003Injection, cerliponase alfa, 1 mg Injection, cerliponase alfa 53 A 1833(t) J0567 DYY20180101 O1E 9F 0201801012019010120181231D C9015001003Injection, c-1 esterase inhibitor (human), haegarda, 10 units C-1 esterase, haegarda 53 A 1833(t) J0599 DYY20180101 O1E 9F 0201801012019010120181231D C9016001003Injection, triptorelin extended release, 3.75 mg Inj, triptorelin ext rel 53 A 1833(t) J3316 DYY20180101 O1E 9F 0201801012019010120181231D C9021001003Injection, obinutuzumab, 10 mg Injection, obinutuzumab 53 A 1833(t) D O1D 9F 0201404012015010120141231N C9022001003Injection, elosulfase alfa, 1mg Injection, elosulfase alfa 53 A 1833(t) J1322 D O1E 9F 0201407012015010120141231N C9023001003Injection, testosterone undecanoate, 1 mg Inj testosterone undecanoate53 A 1833(t) J3145 D O1E 9F 0201410012015010120141231N C9024001003Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine Inj, daunorubicin-cytarabine53 A 1833(t) J9153 DYY20180101 O1D 9F 0201801012019010120181231D C9025001003Injection, ramucirumab, 5 mg Injection, ramucirumab 53 A 1833(t) J9308 D O1D 9F 0201410012016010120151231N C9026001003Injection, vedolizumab, 1 mg Injection, vedolizumab 53 A 1833(t) J3380 D O1E 9F 0201410012016010120151231N C9027001003Injection, pembrolizumab, 1 mg Injection, pembrolizumab 53 A 1833(t) J9271 D O1E 9F 0201501012016010120151231N C9028001003Injection, inotuzumab ozogamicin, 0.1 mg Inj. inotuzumab ozogamicin 53 A 1833(t) J9229 DYY20180101 O1D 9F 0201801012019010120181231D C9029001003Injection, guselkumab, 1 mg Injection, guselkumab 53 A 1833(t) J1628 DYY20180101 O1E 9F 0201801012019010120181231D C9030001003Injection, copanlisib, 1 mg Inj copanlisib 53 A 1833(t) J9057 D O1D 9F 0201807012019010120181231D C9031001003Lutetium lu 177, dotatate, therapeutic, 1 mci Lutetium lu 177 dotatate, tx53 A 1833(t) A9513 D O1D 9F 0201807012019010120181231D C9032001003Injection, voretigene neparvovec-rzyl, 1 billion vector genome Voretigene neparvovec-rzyl 53 A 1833(t) J3398 D O1E 9F 0201807012019010120181231D C9033001003Injection, fosnetupitant 235 mg and palonosetron 0.25 mg Inj, akynzeo 53 A 1833(t) J1454 D O1E 9F 0201810012019010120181231D C9034001003Injection, dexamethasone 9%, intraocular, 1 mcg Injection, dexamethasone 9% 53 A 1833(t) DYY20181001 O1E 9F 02018100120181001 A C9035001003Injection, aripiprazole lauroxil (aristada initio), 1 mg Injection, aristada initio 53 A 1833(t) DYY20190101 O1E 9F 02019010120190101 A C9036001003Injection, patisiran, 0.1 mg Injection, patisiran 53 A 1833(t) DYY20190101 O1E 9F 02019010120190101 A C9037001003Injection, risperidone (perseris), 0.5 mg Injection, risperidone 53 A 1833(t) DYY20190101 O1E 9F 02019010120190101 A C9038001003Injection, mogamulizumab-kpkc, 1 mg Inj mogamulizumab-kpkc 53 A 1833(t) DYY20190101 O1E 9F 02019010120190101 A C9039001003Injection, plazomicin, 5 mg Injection, plazomicin 53 A 1833(t) DYY20190101 O1E 9F 02019010120190101 A 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) J0883 D 0093O1E 1P 0200301012017010120161231N C9132001003Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activityKcentra, per i.u. 53 A 1833(t) DYY20131001 O1E 1F 02013100120131001 N C9133001003Factor ix (antihemophilic factor, recombinant), rixubis, per i.u. Factor ix recombinant 53 A 1833(t) J7200 D O1E 9F 0201401012015010120141231N C9134001003Factor xiii (antihemophilic factor, recombinant), tretten, per 10 i.u. Factor xiii a-subunit recomb53 A 1833(t) J7181 D O1E 9F 0201407012015010120141231N C9135001003Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. Factor ix (alprolix) 53 A 1833(t) J7201 D O1E 9F 0201410012015010120141231N C9136001003Injection, factor viii, fc fusion protein, (recombinant), per i.u. Factor viii (eloctate) 53 A 1833(t) Q9975 D O1E 9F 0201501012015040120150331N C9137001003Injection, factor viii (antihemophilic factor, recombinant) pegylated, 1 i.u. Adynovate factor viii recom 53 A 1833(T) J7207 D O1E 9F 0201604012017010120161231N C9138001003Injection, factor viii (antihemophilic factor, recombinant) (nuwiq), 1 i.u. Nuwiq factor viii recomb 53 A 1833(T) J7209 D O1E 9F 0201604012017010120161231N C9139001003Injection, factor ix, albumin fusion protein (recombinant), idelvion, 1 i.u. Idelvion, 1 i.u. 53 A 1833(t) J7202 D O1E 9F 0201610012017010120161231N C9140001003Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u. Afstyla factor viii recomb 53 A 1833(T) J7210 D O1E 9F 0201701012018010120171231N C9248001003Injection, clevidipine butyrate, 1 mg Inj, clevidipine butyrate 53 A 1833(t) DYY20190101 O1E 1 02009010120190101 P C9250001003Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml Artiss fibrin sealant 53 A 621MMA DYY20170101 O1E 9 02009070120170101 N C9254001003Injection, lacosamide, 1 mg Injection, lacosamide 53 A 621MMA D O1E 9 02010010120100101 N C9257001003Injection, bevacizumab, 0.25 mg Bevacizumab injection 53 A 1833(t) DYY20100101 O1E 9 02010010120100101 N C9275001003Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose Hexaminolevulinate hcl 53 A 1833(t) A9589 D O1E 4 0201101012019010120181231D C9285001003Lidocaine 70 mg/tetracaine 70 mg, per patch Patch, lidocaine/tetracaine 53 A 1833(t) D 0093O1E 1 02011070120140101 N C9290001003Injection, bupivacaine liposome, 1 mg Inj, bupivacaine liposome 53 A 1833(t) DYY20190101 O1E 1 02012040120190101 P C9293001003Injection, glucarpidase, 10 units Injection, glucarpidase 53 A 1833(t) DYY20121001 O1E 1 02012100120121001 N C9349001003Puraply, and puraply antimicrobial, any type, per square centimeter Puraply, puraply antimic 53 A 1833(t) Q4172 D O1E 9F 0201501012017010120161231N 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 D D1A 9 02008070120140101 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 D D1A 9 02009070120140101 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 D D1A 9 02009070120140101 N C9364001003Porcine implant, permacol, per square centimeter Porcine implant, permacol 53 A 621MMA D D1A 9 02009070120090701 N C9399001003Unclassified drugs or biologicals Unclassified drugs or biolog53 A 621MMA DYY20080101 O1E 1 02004010120040101 N C9407001003Iodine i-131 iobenguane, diagnostic, 1 millicurie Iodine i-131 iobenguane, dx 53 A 1833(t) DYY20190101 I1E 4 02019010120190101 A C9408001003Iodine i-131 iobenguane, therapeutic, 1 millicurie Iodine i-131 iobenguane, tx 53 A 1833(t) DYY20190101 I1E 4 02019010120190101 A C9441001003Injection, ferric carboxymaltose, 1 mg Inj, ferric carboxymaltose 53 A 1833(t) D O1E 9F 0201401012014070120140630N C9442001003Injection, belinostat, 10 mg Injection, belinostat 53 A 1833(t) J9032 D O1D 9F 0201501012016010120151231N C9443001003Injection, dalbavancin, 10 mg Injection, dalbavancin 53 A 1833(t) J0875 D O1E 9F 0201501012016010120151231N C9444001003Injection, oritavancin, 10 mg Injection, oritavancin 53 A 1833(t) J2407 D O1E 9F 0201501012016010120151231N C9445001003Injection, c-1 esterase inhibitor (recombinant), ruconest, 10 units C-1 esterase, ruconest 53 A 1833(t) J0596 D O1E 9F 0201504012016010120151231N C9446001003Injection, tedizolid phosphate, 1 mg Inj, tedizolid phosphate 53 A 1833(t) J3090 D O1E 9F 0201501012016010120151231N C9447001003Injection, phenylephrine and ketorolac, 4 ml vial Inj, phenylephrine ketorolac53 A 1833(t) DYY20181001 O1E 9F 02015010120181001 P C9448001003Netupitant 300 mg and palonosetron 0.5 mg, oral Oral netupitant palonosetron53 A 1833(t) Q9978 D O1E 9F 0201504012015070120150630N C9449001003Injection, blinatumomab, 1 mcg Inj, blinatumomab 53 A 1833(t) J9039 D O1D 9F 0201504012016010120151231N C9450001003Injection, fluocinolone acetonide intravitreal implant, 0.01 mg Fluocinolone acetonide implt53 A 1833(t) J7313 D O1E 9F 0201504012016010120151231N C9451001003Injection, peramivir, 1 mg Injection, peramivir 53 A 1833(t) J2547 D O1E 9F 0201504012016010120151231N C9452001003Injection, ceftolozane 50 mg and tazobactam 25 mg Inj, ceftolozane/tazobactam 53 A 1833(t) J0695 D O1E 9F 0201504012016010120151231N C9453001003Injection, nivolumab, 1 mg Injection, nivolumab 53 A 1833(t) J9299 D O1D 9F 0201507012016010120151231N C9454001003Injection, pasireotide long acting, 1 mg Inj, pasireotide long acting53 A 1833(t) J2502 D O1E 9F 0201507012016010120151231N C9455001003Injection, siltuximab, 10 mg Injection, siltuximab 53 A 1833(t) J2860 D O1D 9F 0201507012016010120151231N C9456001003Injection, isavuconazonium sulfate, 1 mg Inj, isavuconazonium sulfate53 A 1833(t) J1833 D O1E 9F 0201510012016010120151231N C9457001003Injection, sulfur hexafluoride lipid microsphere, per ml Lumason contrast agent 53 A 1833(t) Q9950 D O1E 4F 0201510012016010120151231N C9458001003Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries Florbetaben f18 53 A 1833(t) Q9983 D O1E 4F 0201601012016070120160630N C9459001003Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries Flutemetamol f18 53 A 1833(t) Q9982 D O1E 4F 0201601012016070120160630N C9460001003Injection, cangrelor, 1 mg Injection, cangrelor 53 A 1833(t) DYY20160101 O1E 1F 02016010120160101 N C9461001003Choline c 11, diagnostic, per study dose Choline c 11, diagnostic 53 A 1833(T) A9515 D I1E 4F 0201604012017010120161231N C9462001003Injection, delafloxacin, 1 mg Injection, delafloxacin 53 A 1833(t) DYY20180401 O1E 9F 02018040120180401 A C9463001003Injection, aprepitant, 1 mg Injection, aprepitant 53 A 1833(t) J0185 D O1E 9F 0201804012019010120181231D C9464001003Injection, rolapitant, 0.5 mg Injection, rolapitant 53 A 1833(t) J2797 D O1E 9F 0201804012019010120181231D C9465001003Hyaluronan or derivative, durolane, for intra-articular injection, per dose Injection, durolane 53 A 1833(t) J7318 D O1E 9F 0201804012019010120181231D C9466001003Injection, benralizumab, 1 mg Injection, benralizumab 53 A 1833(t) J0517 D O1E 9F 0201804012019010120181231D C9467001003Injection, rituximab and hyaluronidase, 10 mg Inj rituximab hyaluronidase 53 A 1833(t) J9311 D O1E 9F 0201804012019010120181231D C9468001003Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, Inj, factor ix, rebinyn 53 A 1833(t) J7023 D O1E 9F 0201804012019010120181231D C9468002004rebinyn, 1 i.u. C9469001003Injection, triamcinolone acetonide, preservative-free, extended-release, Inj triamcinolone acetonide 53 A 1833(t) Q9993 D O1E 9F 0201804012018070120180630D C9469002004microsphere formulation, 1 mg C9470001003Injection, aripiprazole lauroxil, 1 mg Aripiprazole lauroxil im 53 A 1833(T) J1942 D O1E 9F 0201604012017010120161231N C9471001003Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg Hymovis, 1 mg 53 A 1833(T) J7322 D O1E 9F 0201604012017010120161231N C9472001003Injection, talimogene laherparepvec, 1 million plaque forming units (pfu) Inj talimogene laherparepvec53 A 1833(T) J9325 D O1D 9F 0201604012017010120161231N C9473001003Injection, mepolizumab, 1 mg Injection, mepolizumab 53 A 1833(T) J2182 D O1E 9F 0201604012017010120161231N C9474001003Injection, irinotecan liposome, 1 mg Inj, irinotecan liposome 53 A 1833(T) J9205 D O1D 9F 0201604012017010120161231N C9475001003Injection, necitumumab, 1 mg Injection, necitumumab 53 A 1833(T) J9295 D O1D 9F 0201604012017010120161231N C9476001003Injection, daratumumab, 10 mg Injection, daratumumab 53 A 1833(t) J9145 D O1D 9F 0201607012017010120161231N C9477001003Injection, elotuzumab, 1 mg Injection, elotuzumab 53 A 1833(t) J9176 D O1D 9F 0201607012017010120161231N C9478001003Injection, sebelipase alfa, 1 mg Injection, sebelipase alfa 53 A 1833(t) J2840 D O1E 9F 0201607012017010120161231N C9479001003Instillation, ciprofloxacin otic suspension, 6 mg Instill, ciprofloxacin otic 53 A 1833(t) J7342 D O1E 9F 0201607012017010120161231N C9480001003Injection, trabectedin, 0.1 mg Injection, trabectedin 53 A 1833(t) J9352 D O1D 9F 0201607012017010120161231N C9481001003Injection, reslizumab, 1 mg Injection, reslizumab 53 A 1833(t) J2786 D O1E 9F 0201610012017010120161231N C9482001003Injection, sotalol hydrochloride, 1 mg Sotalol hydrochloride iv 53 A 1833(t) DYY20161001 O1E 9F 02016100120161001 N C9483001003Injection, atezolizumab, 10 mg Injection, atezolizumab 53 A 1833(t) J9022 D O1D 9F 0201610012018010120171231N C9484001003Injection, eteplirsen, 10 mg Injection, eteplirsen 53 A 1833(t) J1428 D O1E 9F 0201704012018010120171231N C9485001003Injection, olaratumab, 10 mg Injection, olaratumab 53 A 1833(t) J9285 D O1D 9F 0201704012018010120171231N C9486001003Injection, granisetron extended release, 0.1 mg Inj, granisetron ext 53 A 1833(t) J1627 D O1E 9F 0201704012018010120171231N C9487001003Ustekinumab, for intravenous injection, 1 mg Ustekinumab iv inj, 1 mg 53 A 1833(t) Q9989 D O1E 9F 0201704012017070120170630N C9488001003Injection, conivaptan hydrochloride, 1 mg Conivaptan hcl 53 A 1833(t) DYY20170401 O1E 9F 02017040120170401 N C9489001003Injection, nusinersen, 0.1 mg Injection, nusinersen 53 A 1833(t) J2326 D O1E 9F 0201707012018010120171231N C9490001003Injection, bezlotoxumab, 10 mg Injection, bezlotoxumab 53 A 1833(t) J0565 D O1E 9F 0201707012018010120171231N C9491001003Injection, avelumab, 10 mg Injection, avelumab 53 A 1833(t) J9023 D O1D 9F 0201710012018010120171231N C9492001003Injection, durvalumab, 10 mg Injection, durvalumab 53 A 1833(t) J9173 DYY20171001 O1D 9F 0201710012019010120181231D C9493001003Injection, edaravone, 1 mg Injection, edaravone 53 A 1833(t) J1301 DYY20171001 O1E 9F 0201710012019010120181231D C9494001003Injection, ocrelizumab, 1 mg Injection, ocrelizumab 53 A 1833(t) J2350 D O1E 9F 0201710012018010120171231N C9497001003Loxapine, inhalation powder, 10 mg Loxapine, inhalation powder 53 A 1833(t) J2062 DYY20140101 O1E 9F 0201401012019010120181231D C9600001003Percutaneous transcatheter placement of drug eluting intracoronary stent(s), Perc drug-el cor stent sing 53 A 1833(t) D 0107P2F 2 02013010120130101 N 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 N 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 N 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 N 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 N 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 N 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 graft C9605005004(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 N 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 N 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 N C9608002004coronary artery, coronary artery branch, or coronary artery bypass graft, any C9608003004combination of drug-eluting intracoronary stent, atherectomy and C9608004004angioplasty; each additional coronary artery, coronary artery branch, or bypass C9608005004graft (list separately in addition to code for primary procedure) C9724001003Endoscopic full-thickness plication of the stomach using endoscopic plication Eps stomach plic 53 A 1833(T) 43210 D P8I 2 0200504012016010120151231N 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 Rxt breast appl place/remov 53 A 1833(T) D P7A 6 02006010120140101 N C9726002004intraoperative radiation therapy, add-on to primary breast procedure 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 Place device/marker, non pro53 A 1833(T) DYY20130101 P5E 2 02007070120100101 N C9728002004(e.g., fiducial markers, dosimeter), for other than the following sites (any C9728003004approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or C9728004004multiple C9733001003Non-ophthalmic fluorescent vascular angiography Non-ophthalmic fva 53 A 1833(t) D I4B 4 02012040120120401 N C9734001003Focused ultrasound ablation/therapeutic intervention, other than uterine U/s trtmt, not leiomyomata 53 A 1833(t) D P5E 2 02013040120130701 N C9734002004leiomyomata, with magnetic resonance (mr) guidance C9735001003Anoscopy; with directed submucosal injection(s), any substance Anoscopy, submucosal inj 53 A 1833(t) 0377T D P8I 2 0201304012015010120141231N C9737001003Laparoscopy, surgical, esophageal sphincter augmentation with device (e.g., Lap esoph augmentation 53 A 1833(t) 0392T D O1E 2F 0201401012015070120150630N C9737002004magnetic band) C9738001003Adjunctive blue light cystoscopy with fluorescent imaging agent (list Blue light cysto imag agent 53 A 1833(t) D I1F 1F 02018010120180101 N C9738002004separately in addition to code for primary procedure) C9739001003Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants Cystoscopy prostatic imp 1-353 A 1833(t) DYY20140401 P5E 2F 02014040120140401 N C9740001003Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants Cysto impl 4 or more 53 A 1833(t) DYY20140401 P5E 2F 02014040120140401 N C9741001003Right heart catheterization with implantation of wireless pressure sensor in Impl pressure sensor w/angio53 A 1833(t) 33289 D P6D 2F 0201410012019010120181231D C9741002004the pulmonary artery, including any type of measurement, angiography, imaging C9741003004supervision, interpretation, and report C9742001003Laryngoscopy, flexible fiberoptic, with injection into vocal cord(s), Laryngoscopy with injection 53 A 1833(t) 3157331574 D P8H 2F 0201501012017010120161231N C9742002004therapeutic, including diagnostic laryngoscopy, if performed C9743001003Injection/implantation of bulking or spacer material (any type) with or without Bulking/spacer material impl53 A 1833(t) 0438T D P6C 2F 0201510012016070120160630N C9743002004image guidance (not to be used if a more specific code applies) C9744001003Ultrasound, abdominal, with contrast Abd us w/contrast 53 A 1833(t) 7697876979 D I3B 4F 0201610012019010120181231D C9745001003Nasal endoscopy, surgical; balloon dilation of eustachian tube Nasal endo eustachian tube 53 A 1833(t) DYY20170701 P8I 2F 02017070120170701 N C9746001003Transperineal implantation of permanent adjustable balloon continence device, Trans imp balloon cont 53 A 1833(t) DYY20170701 P6C 2F 02017070120170701 N C9746002004with cystourethroscopy, when performed and/or fluoroscopy, when performed C9747001003Ablation of prostate, transrectal, high intensity focused ultrasound (hifu), Ablation, hifu, prostate 53 A 1833(t) DYY20170701 P6C 2F 02017070120170701 N C9747002004including imaging guidance C9748001003Transurethral destruction of prostate tissue; by radiofrequency water vapor Prostatic rf water vapor tx 53 A 1833(t) 53854 D P5E 2F 0201801012019010120181231D C9748002004(steam) thermal therapy C9749001003Repair of nasal vestibular lateral wall stenosis with implant(s) Repair nasal stenosis w/imp 53 A 1833(t) DYY20180401 P5E 2F 02018040120180401 A C9750001003Insertion or removal and replacement of intracardiac ischemia monitoring system Ins/rem-replace compl iims 53 A 1833(t) 0525T D P6C 2F 0201810012019010120181231D C9750002004including imaging supervision and interpretation and peri-operative C9750003004interrogation and programming; complete system (includes device and electrode) C9751001003Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by Microwave bronch, 3d, ebus 53 A 1833(t) D P8F 2 02019010120190101 A C9751002004microwave energy, including fluoroscopic guidance, when performed, with C9751003004computed tomography acquisition(s) and 3-d rendering, computer-assisted, C9751004004image-guided navigation, and endobronchial ultrasound (ebus) guided C9751005004transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]) C9751006004and all mediastinal and/or hilar lymph node stations or structures and C9751007004therapeutic intervention(s) C9752001003Destruction of intraosseous basivertebral nerve, first two vertebral bodies, Intraosseous des lumb/sacrum53 A 1833(t) DYY20190101 P5B 2 02019010120190101 A C9752002004including imaging guidance (e.g., fluoroscopy), lumbar/sacrum C9753001003Destruction of intraosseous basivertebral nerve, each additional vertebral Intraosseous destruct add'l 53 A 1833(t) D P5B 2 02019010120190101 A C9753002004body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list C9753003004separately in addition to code for primary procedure) C9754001003Creation of arteriovenous fistula, percutaneous; direct, any site, including Perc av fistula, direct 53 A 1833(t) DYY20190101 P5E 2 02019010120190101 A C9754002004all imaging and radiologic supervision and interpretation, when performed and C9754003004secondary procedures to redirect blood flow (e.g., transluminal balloon C9754004004angioplasty, coil embolization, when performed) C9755001003Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial Rf magnetic-guide av fistula53 A 1833(t) DYY20190101 P5E 2 02019010120190101 A C9755002004and venous catheters and radiofrequency energy, including flow-directing C9755003004procedures (e.g., vascular coil embolization with radiologic supervision and C9755004004interpretation, when performed) and fistulogram(s), angiography, venography, C9755005004and/or ultrasound, with radiologic supervision and interpretation, when C9755006004performed C9800001003Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and Dermal filler inj px/suppl 53 A 1833(t) G0429 D 0093P6A 1 0201007012017010120161231N C9800002004provision of radiesse or sculptra dermal filler, including all items and C9800003004supplies 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 E0100001003Cane, 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 E0110001003Crutches, forearm, includes crutches of various materials, adjustable or fixed, Crutch forearm pair 32 A60-9 2100.1 D D1E APR 01986010119960101 N E0110002004pair, 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 crutch36 A 2100.1 D D1E APR 02003010120140401 N E0118001003Crutch substitute, lower leg platform, with or without wheels, each Crutch substitute 32 A C D1E APR 02004010120040401 N E0130001003Walker, 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 36 A60-9 2100.1 D D1E APR 02004010120160701 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 36 A60-9 2100.1 D D1E APR 02000010120140401 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 36 A C D1E APR 02001010120160701 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 E0156001003Seat 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 E0160001003Sitz 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 mattres36 A60-9 D D1E APR 01991010120160701 N E0198001003Water pressure pad for mattress, standard mattress length and width Water pressure pad for mattr36 A60-9 D D1E APR 01991010120140401 N E0199001003Dry pressure pad for mattress, standard mattress length and width Dry pressure pad for mattres32 A60-9 D D1E APR 01991010119980101 N E0200001003Heat 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 ALP 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 E0218001003Fluid circulating cold pad with pump, any type Fluid circ cold pad w pump 36 A60-9 D D1E APR 01997010120190101 C 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 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 E0239001003Hydrocollator unit, portable Hydrocollator unit portable 32 A60-9 2210.3 D D1E APR 01986010119960101 N E0240001003Bath/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 E0250001003Hospital 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 no sr w/matt36 A60-18 2100.1 D D1B R 01991010120170101 N E0293001003Hospital bed, variable height, hi-lo, without side rails, without mattress Hosp bed var ht no sr no mat36 A60-18 2100.1 D D1B R 01991010120170101 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 grade36 A C D1B APR 02004010120140401 N 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 E0305001003Bed 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 E0370001003Air 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 C 0170D1E 9 02011010120171001 N E0446002004and accessories E0447001003Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount Port o2 cont, liq over 4 lpm33 A60.4 4107.9 D D1C P 02019010120190101 A E0447002004at rest or nighttime exceeds 4 liters per minute (lpm) E0450001003Volume control ventilator, without pressure support mode, may include pressure Vol control vent invasiv int31 A60-9 D D1E R 0198501012016010120151231N 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 00 9 I D1E APR 01990010120140101 N E0459001003Chest wrap Chest wrap 00 9 I D1E R 01990010120140101 N E0460001003Negative pressure ventilator; portable or stationary Neg press vent portabl/statn31 A60-9 D D1E R 0199001012016010120151231N E0461001003Volume control ventilator, without pressure support mode, may include pressure Vol control vent noninv int 31 A60-9 D D1E R 0200301012016010120151231N 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 0200501012016010120151231N 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 0200501012016010120151231N E0464002004control mode, used with non-invasive interface (e.g., mask) E0465001003Home ventilator, any type, used with invasive interface, (e.g., tracheostomy Home vent invasive interface31 A 60-9 D 0137D1E R 02016010120160101 N E0465002004tube) E0466001003Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest Home vent non-invasive inter31 A 60-9 D 0137D1E R 02016010120160101 N E0466002004shell) E0467001003Home ventilator, multi-function respiratory device, also performs any or all of Home vent multi-function 31 A60.9 D 0137D1E R 02019010120190101 A E0467002004the additional functions of oxygen concentration, drug nebulization, E0467003004aspiration, and cough stimulation, includes all accessories, components and E0467004004supplies for all functions 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 system, includes all accessories and Hi freq chest wall oscil sys36 A C D1E R 02003010120190101 C E0483002004supplies, 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 E0500001003Ippb machine, all types, with built-in nebulization; manual or automatic Ippb all types 31 A60-9 D D1E R 01986010119860101 N E0500002004valves; internal or external power source E0550001003Humidifier, durable for extensive supplemental humidification during ippb Humidif extens supple w ippb33 A60-9 D D1E R 01986010120050701 N E0550002004treatments 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 01982010119820101 N E0565002004cylinder driven E0570001003Nebulizer, with compressor Nebulizer with compression 36 A60-9 4107.9 D D1E R 01986010119960101 N 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 36 A60-9 D D1E R 01986010120180101 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 E0600001003Respiratory suction pump, home model, portable or stationary, electric Suction pump portab hom modl36 A60-9 D D1E R 01986010120020101 N E0601001003Continuous positive airway pressure (cpap) device Cont airway pressure device 36 A60-17 D D1E R 01988010120140101 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 E0607001003Home 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 E0620001003Skin piercing device for collection of capillary blood, laser, each Cap bld skin piercing laser 36 A C D1E APR 02002010120140401 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, electric, any type Seat lift mech, electric any32 A60-8 4107.8 D D1E APR 01992010120170101 N E0628001003Separate seat lift mechanism for use with patient owned furniture-electric Seat lift for pt furn-electr32 A60-8 4107.8 D D1E APR 0199201012017010120161231N E0629001003Seat lift mechanism, non-electric, any type Seat lift mech, non-electric32 A 4107.8 D D1E APR 01992010120170101 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 E0650001003Pneumatic 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 36 A D 0125D1E APR 02009010120140401 N E0657001003Segmental pneumatic appliance for use with pneumatic compressor, chest Segmental pneumatic chest 36 A D 0125D1E APR 02009010120140401 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 N 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 E0700001003Safety 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 E0710001003Restraints, any type (body, chest, wrist or ankle) Restraints any type 57 A C Z2 APR 01986010119960101 N E0720001003Transcutaneous electrical nerve stimulation (tens) device, two lead, localized Tens two lead 32 A35-20 35-46 4107.6 D D1E APR 01986010120070101 N E0720002004stimulation 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) E0740001003Non-implanted pelvic floor electrical stimulator, complete system Non-implant pelv flr e-stim 36 A60.24 D D1E APR 01986010120170101 N 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 neuromuscularstim36 A35-77 D D1F APR 02006010120140401 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 E0766001003Electrical stimulation device used for cancer treatment, includes all Elec stim cancer treatment 31 A C D1E R 02014010120140101 N E0766002004accessories, any type 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 AEP 01985010119960101 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 E0783002004pump, 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 E0840001003Traction 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 36 A C D1E APR 02005010120140401 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 36 A C D1E APR 01998010120140401 N E0856001003Cervical traction device, with inflatable air bladder(s) Cervic collar w air bladders36 A C D1E APR 02008010120150101 N E0860001003Traction equipment, overdoor, cervical Tract equip cervical tract 32 A60-9 D D1E APR 01986010119890101 N E0870001003Traction 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 E0890001003Traction 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 E0910001003Trapeze 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 E0950001003Wheelchair accessory, tray, each Tray 32 A60-9 D D1D APR 01986010120180101 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 E0953001003Wheelchair accessory, lateral thigh or knee support, any type including fixed W/c lateral thigh/knee sup 32 A C D1D APR 02018010120180101 N E0953002004mounting hardware, each E0954001003Wheelchair accessory, foot box, any type, includes attachment and mounting Foot box, any type each foot32 A C D1D APR 02018010120180101 N E0954002004hardware, each foot E0955001003Wheelchair accessory, headrest, cushioned, any type, including fixed mounting Cushioned headrest 36 A C D1D APR 02004010120160701 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 E0958001003Manual 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, replacement Man wc rim/projection rep ea32 A60-9 D D1D APR 01986010120170101 N E0967002004only, each 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 36 A C D1D APR 02004010120140401 N E0984002004motorized wheelchair, tiller control E0985001003Wheelchair accessory, seat lift mechanism W/c seat lift mechanism 36 A C D1D APR 02004010120160701 N E0986001003Manual wheelchair accessory, push-rim activated power assist system Man w/c push-rim powr system36 A C D1D APR 02004010120150101 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, replacement only, each Wc calf rest, pad replacemnt00 960-9 C D1D APR 01986010120170101 N E1002001003Wheelchair accessory, power seating system, tilt only Pwr seat tilt 36 A C D1D APR 02004010120140401 N E1003001003Wheelchair accessory, power seating system, recline only, without shear Pwr seat recline 36 A C D1D APR 02004010120140401 N E1003002004reduction E1004001003Wheelchair accessory, power seating system, recline only, with mechanical shear Pwr seat recline mech 36 A C D1D APR 02004010120140401 N E1004002004reduction E1005001003Wheelchair accessory, power seatng system, recline only, with power shear Pwr seat recline pwr 36 A C D1D APR 02004010120140401 N E1005002004reduction E1006001003Wheelchair accessory, power seating system, combination tilt and recline, Pwr seat combo w/o shear 36 A C D1D APR 02004010120140401 N E1006002004without shear reduction E1007001003Wheelchair accessory, power seating system, combination tilt and recline, with Pwr seat combo w/shear 36 A C D1D APR 02004010120140401 N E1007002004mechanical shear reduction E1008001003Wheelchair accessory, power seating system, combination tilt and recline, with Pwr seat combo pwr shear 36 A C D1D APR 02004010120140401 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 36 A C D1D APR 02004010120140401 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) E1012001003Wheelchair accessory, addition to power seating system, center mount power Ctr mount pwr elev leg rest 36 A C D1D APR 02016010120160101 N E1012002004elevating leg rest/platform, complete system, any type, each E1014001003Reclining back, addition to pediatric size wheelchair Reclining back add ped w/c 36 A60-9 D D1D APR 02003010120140401 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 system36 A 60-6 D D1D APR 02003010120160701 N E1028001003Wheelchair accessory, manual swingaway, retractable or removable mounting W/c manual swingaway 36 A C D1D APR 02004010120160701 N E1028002004hardware for joystick, other control interface or positioning accessory E1029001003Wheelchair accessory, ventilator tray, fixed W/c vent tray fixed 36 A C D1D APR 02004010120140401 N E1030001003Wheelchair accessory, ventilator tray, gimbaled W/c vent tray gimbaled 36 A C D1D APR 02004010120140401 N E1031001003Rollabout chair, any and all types with casters 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 E1050001003Fully-reclining wheelchair, fixed full length arms, swing away detachable Whelchr fxd full length arms36 A60-9 D D1D R 01986010119840101 N E1050002004elevating 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 E1100001003Semi-reclining wheelchair, fixed full length arms, swing away detachable Whchr s-recl fxd arm leg res36 A60-9 D D1D R 01986010119880101 N E1100002004elevating 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 E1130001003Standard wheelchair, fixed full length arms, fixed or swing away detachable Whlchr stand fxd arm ft rest00 960-9 K0001 I D1D R 01986010120010401 N E1130002004footrests 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 tiltinspac36 A C D1D APR 02003010120140401 N E1170001003Amputee wheelchair, fixed full length arms, swing away detachable elevating Whlchr ampu fxd arm leg rest36 A60-9 D D1D R 01986010119890101 N E1170002004legrests 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 E1220001003Wheelchair; specially sized or constructed, (indicate brand name, model number, Whlchr special size/constrc 45 A60-6 D D1D P 01986010119900101 N E1220002004if 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-space36 A60-9 D D1D APR 02003010120140401 N E1232002004system E1233001003Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating Rig ped wc tltnspc w/o seat 36 A60-9 D D1D APR 02003010120140401 N E1233002004system E1234001003Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating Fld ped wc tltnspc w/o seat 36 A60-9 D D1D APR 02003010120140401 N E1234002004system E1235001003Wheelchair, pediatric size, rigid, adjustable, with seating system Rigid ped wc adjustable 36 A60-9 D D1D APR 02003010120140401 N E1236001003Wheelchair, pediatric size, folding, adjustable, with seating system Folding ped wc adjustable 36 A60-9 D D1D APR 02003010120140401 N E1237001003Wheelchair, pediatric size, rigid, adjustable, without seating system Rgd ped wc adjstabl w/o seat36 A60-9 D D1D APR 02003010120140401 N E1238001003Wheelchair, pediatric size, folding, adjustable, without seating system Fld ped wc adjstabl w/o seat36 A60-9 D D1D APR 02003010120140401 N E1239001003Power wheelchair, pediatric size, not otherwise specified Ped power wheelchair nos 36 A C D1D APR 02005010120050101 N E1240001003Lightweight wheelchair, detachable arms, (desk or full length) swing away Whchr litwt det arm leg rest36 A60-9 D D1D R 01986010119890101 N E1240002004detachable, 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 E1280001003Heavy 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 E1300001003Whirlpool, 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 E1352001003Oxygen accessory, flow regulator capable of positive inspiratory pressure O2 flow reg pos inspir press00 9 C D1C P 02014010120140101 N E1353001003Regulator 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 D 0197D1C APR 02009010120150101 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 00 9 D 0017P9B L 02002010120150101 N E1510001003Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal Kidney dialysate delivry sys00 9 D 0017P9B L 01986010120150101 N E1510002004syst, flowrate meter, power off, heater and temperature control with alarm, E1510003004i.v. poles, pressure gauge, concentrate container E1520001003Heparin infusion pump for hemodialysis Heparin infusion pump 00 9 D 0017P9B L 01986010120150101 N E1530001003Air bubble detector for hemodialysis, each, replacement Replacement air bubble detec00 9 D 0017P9B L 01986010120150101 N E1540001003Pressure alarm for hemodialysis, each, replacement Replacement pressure alarm 00 9 D 0017P9B L 01986010120150101 N E1550001003Bath conductivity meter for hemodialysis, each Bath conductivity meter 00 9 D 0017P9B L 01986010120150101 N E1560001003Blood leak detector for hemodialysis, each, replacement Replace blood leak detector 00 9 D 0017P9B L 01986010120150101 N E1570001003Adjustable chair, for esrd patients Adjustable chair for esrd pt00 9 D 0017P9B L 01986010120150101 N E1575001003Transducer protectors/fluid barriers, for hemodialysis, any size, per 10 Transducer protect/fld bar 00 9 D 0017P9B L 01986010120150101 N E1580001003Unipuncture control system for hemodialysis Unipuncture control system 00 9 D 0017P9B L 01986010120150101 N E1590001003Hemodialysis machine Hemodialysis machine 00 9 D 0017P9B L 01986010120150101 N E1592001003Automatic intermittent peritoneal dialysis system Auto interm peritoneal dialy00 9 D 0017P9B L 01986010120150101 N E1594001003Cycler dialysis machine for peritoneal dialysis Cycler dialysis machine 00 9 D 0017P9B L 01986010120150101 N E1600001003Delivery and/or installation charges for hemodialysis equipment Deli/install chrg hemo equip00 9 D 0017P9B L 01986010120150101 N E1610001003Reverse osmosis water purification system, for hemodialysis Reverse osmosis h2o puri sys00 955-1A D 0017P9B L 01986010120150101 N E1615001003Deionizer water purification system, for hemodialysis Deionizer h2o puri system 00 955-1A D 0017P9B L 01986010120150101 N E1620001003Blood pump for hemodialysis, replacement Replacement blood pump 00 9 D 0017P9B L 01986010120150101 N E1625001003Water softening system, for hemodialysis Water softening system 00 955-1B D 0017P9B L 01986010120150101 N E1630001003Reciprocating peritoneal dialysis system Reciprocating peritoneal dia00 9 C 0017P9B L 01986010120150101 N E1632001003Wearable artificial kidney, each Wearable artificial kidney 00 9 D 0017P9B L 01986010120150101 N E1634001003Peritoneal dialysis clamps, each Peritoneal dialysis clamp 00 9 4270 D P9B L 02004010120150101 N E1635001003Compact (portable) travel hemodialyzer system Compact travel hemodialyzer 00 9 D 0017P9B L 01986010120150101 N E1636001003Sorbent cartridges, for hemodialysis, per 10 Sorbent cartridges per 10 00 9 D 0017P9B L 01986010120150101 N E1637001003Hemostats, each Hemostats for dialysis, each00 9 D 0017P9B L 02002010120150101 N E1639001003Scale, each Scale, each 00 9 D 0017P9B L 02002010120180101 N E1699001003Dialysis equipment, not otherwise specified Dialysis equipment noc 00 9 D 0017P9B L 01986010120150101 N E1700001003Jaw motion rehabilitation system Jaw motion rehab system 36 A C D1E APR 01993010120140401 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 E1800001003Dynamic adjustable elbow extension/flexion device, includes soft interface Adjust elbow ext/flex device36 A C D1E PR 01996010120020101 N E1800002004material 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 E2201001003Manual wheelchair accessory, nonstandard seat frame, width greater than or Man w/ch acc seat w>=20"<24"32 A C D1D APR 02004010120040101 N E2201002004equal 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, replacement only, Man wc whl lock comp repl ea32 A C D1D APR 02005010120170101 N E2206002004each 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 propuls tire, repl, ea32 A C D1D APR 02006010120170101 N E2220002004replacement only, each E2221001003Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), Solid caster tire repl, each32 A C D1D APR 02006010120170101 N E2221002004any size, replacement only, each E2222001003Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated Solid caster integ whl, repl32 A C D1D APR 02006010120170101 N E2222002004wheel, any size, replacement only, each E2224001003Manual wheelchair accessory, propulsion wheel excludes tire, any size, Propulsion whl excl tire rep32 A C D1D APR 02006010120170101 N E2224002004replacement only, each 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 36 A C D1D APR 02008010120140401 N E2228001003Manual wheelchair accessory, wheel braking system and lock, complete, each Mwc acc, wheelchair brake 36 A C D1D APR 02008010120160701 N E2230001003Manual wheelchair accessory, manual standing system Manual standing system 00 9 C D1D APR 02009010120150101 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 E2300001003Wheelchair accessory, power seat elevation system, any type Pwr seat elevation sys 32 A C D1D APR 02004010120140101 N E2301001003Wheelchair accessory, power standing system, any type Pwr standing 00 9 C D1D APR 02004010120140101 N E2310001003Power wheelchair accessory, electronic connection between wheelchair controller Electro connect btw control 36 A C D1D APR 02004010120140401 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 36 A C D1D APR 02004010120140401 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 36 A C D1D APR 02008010120140401 N E2312002004remote joystick, proportional, including fixed mounting hardware E2313001003Power wheelchair accessory, harness for upgrade to expandable controller, Pwc harness, expand control 36 A C D1D APR 02008010120140401 N E2313002004including all fasteners, connectors and mounting hardware, each E2321001003Power wheelchair accessory, hand control interface, remote joystick, Hand interface joystick 36 A C D1D APR 02004010120140401 N E2321002004nonproportional, including all related electronics, mechanical stop switch, and E2321003004fixed mounting hardware E2322001003Power wheelchair accessory, hand control interface, multiple mechanical Mult mech switches 36 A C D1D APR 02004010120140401 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 36 A C D1D APR 02004010120140401 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 36 A C D1D APR 02004010120140401 N E2327001003Power wheelchair accessory, head control interface, mechanical, proportional, Head control interface mech 36 A C D1D APR 02004010120140401 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 inter36 A C D1D APR 02004010120140401 N E2328002004electronic, proportional, including all related electronics and fixed mounting E2328003004hardware E2329001003Power wheelchair accessory, head control interface, contact switch mechanism, Head control nonproportional36 A C D1D APR 02004010120140401 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 switc36 A C D1D APR 02004010120140401 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 02004010120190101 P 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, 22nf 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 repl36 A C D1D APR 02005010120160701 N E2369001003Power wheelchair component, drive wheel gear box, replacement only Pwr wc drivewheel gear repl 36 A C D1D APR 02005010120160701 N E2370001003Power wheelchair component, integrated drive wheel motor and gear box Pwr wc dr wh motor/gear comb36 A C D1D APR 02005010120160701 N 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 joystick36 A C D1D APR 02007010120140401 N E2373002004joystick, proportional, including fixed mounting hardware E2374001003Power wheelchair accessory, hand or chin control interface, standard remote Hand/chin ctrl std joystick 36 A D 0125D1D APR 02007010120140401 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 36 A D 0125D1D APR 02007010120160701 N E2375002004electronics and mounting hardware, replacement only E2376001003Power wheelchair accessory, expandable controller, including all related Expandable controller, repl 36 A D 0125D1D APR 02007010120140401 N E2376002004electronics and mounting hardware, replacement only E2377001003Power wheelchair accessory, expandable controller, including all related Expandable controller, initl36 A D 0125D1D APR 02007010120140401 N E2377002004electronics and mounting hardware, upgrade provided at initial issue E2378001003Power wheelchair component, actuator, replacement only Pw actuator replacement 36 A C D1D APR 02013010120140401 N 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 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 E2402001003Negative pressure wound therapy electrical pump, stationary or portable Neg press wound therapy pump36 A C D1E R 02004010120040101 N E2500001003Speech generating device, digitized speech, using pre-recorded messages, less Sgd digitized pre-rec <=8min32 A60-23 D D1E APR 02004010120190101 P E2500002004than 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 02004010120190101 P 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 02004010120190101 P 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 02004010120190101 P 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 02004010120190101 P 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 02004010120190101 P 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 46 A60-23 D D1E APR 02004010120140401 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 G0068001003Professional services for the administration of anti-infective, pain Adm of infusion drug in home13 A C M4A 1 02019010120190101 A G0068002004management, chelation, pulmonary hypertension, and/or inotropic infusion G0068003004drug(s) for each infusion drug administration calendar day in the individual's G0068004004home, each 15 minutes G0069001003Professional services for the administration of subcutaneous immunotherapy for Adm of immune drug in home 13 A C M4A 1 02019010120190101 A G0069002004each infusion drug administration calendar day in the individual's home, each G006900300415 minutes G0070001003Professional services for the administration of chemotherapy for each infusion Adm of chemo drug in home 13 A C M4A 1 02019010120190101 A G0070002004drug administration calendar day in the individual's home, each 15 minutes G0071001003Payment for communication technology-based services for 5 minutes or more of a Comm svcs by rhc/fqhc 5 min 13 A C M5D 1 02019010120190101 A G0071002004virtual (non-face-to-face) communication between an rural health clinic (rhc) G0071003004or federally qualified health center (fqhc) practitioner and rhc or fqhc G0071004004patient, or 5 minutes or more of remote evaluation of recorded video and/or G0071005004images by an rhc or fqhc practitioner, occurring in lieu of an office visit; G0071006004rhc or fqhc only G0076001003Brief (20 minutes) care management home visit for a new patient. for use only Care manag h vst new pt 20 m13 A C M4A 1 02019010120190101 A G0076002004in a medicare-approved cmmi model. (services must be furnished within a G0076003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0076004004facility) G0077001003Limited (30 minutes) care management home visit for a new patient. for use only Care manag h vst new pt 30 m13 A C M4A 1 02019010120190101 A G0077002004in a medicare-approved cmmi model. (services must be furnished within a G0077003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0077004004facility) G0078001003Moderate (45 minutes) care management home visit for a new patient. for use Care manag h vst new pt 45 m13 A C M4A 1 02019010120190101 A G0078002004only in a medicare-approved cmmi model. (services must be furnished within a G0078003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0078004004facility) G0079001003Comprehensive (60 minutes) care management home visit for a new patient. for Care manag h vst new pt 60 m13 A C M4A 1 02019010120190101 A G0079002004use only in a medicare-approved cmmi model. (services must be furnished within G0079003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0079004004facility) G0080001003Extensive (75 minutes) care management home visit for a new patient. for use Care manag h vst new pt 75 m13 A C M4A 1 02019010120190101 A G0080002004only in a medicare-approved cmmi model. (services must be furnished within a G0080003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0080004004facility) G0081001003Brief (20 minutes) care management home visit for an existing patient. for use Care man h v ext pt 20 mi 13 A C M4A 1 02019010120190101 A G0081002004only in a medicare-approved cmmi model. (services must be furnished within a G0081003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0081004004facility) G0082001003Limited (30 minutes) care management home visit for an existing patient. for Care man h v ext pt 30 m 13 A C M4A 1 02019010120190101 A G0082002004use only in a medicare-approved cmmi model. (services must be furnished within G0082003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0082004004facility) G0083001003Moderate (45 minutes) care management home visit for an existing patient. for Care man h v ext pt 45 m 13 A C M4A 1 02019010120190101 A G0083002004use only in a medicare-approved cmmi model. (services must be furnished within G0083003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0083004004facility) G0084001003Comprehensive (60 minutes) care management home visit for an existing patient. Care man h v ext pt 60 m 13 A C M4A 1 02019010120190101 A G0084002004for use only in a medicare-approved cmmi model. (services must be furnished G0084003004within a beneficiary's home, domiciliary, rest home, assisted living and/or G0084004004nursing facility) G0085001003Extensive (75 minutes) care management home visit for an existing patient. for Care man h v ext pt 75 m 13 A C M4A 1 02019010120190101 A G0085002004use only in a medicare-approved cmmi model. (services must be furnished within G0085003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0085004004facility) G0086001003Limited (30 minutes) care management home care plan oversight. for use only in Care man home care plan 30 m13 A C M4A 1 02019010120190101 A G0086002004a medicare-approved cmmi model. (services must be furnished within a G0086003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0086004004facility) G0087001003Comprehensive (60 minutes) care management home care plan oversight. for use Care man home care plan 60 m13 A C M4A 1 02019010120190101 A G0087002004only in a medicare-approved cmmi model. (services must be furnished within a G0087003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G0087004004facility) 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 02002010120020101 N G0118002004of an optometrist or ophthalmologist 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 D 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) (e.g., 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 0199907012016030120160229N 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 0201101012017010120161231N 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 0201101012017010120161231N 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 D 0094P5E 2 0200008012015010120141231N 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, bilateral (2-view study of each breast), including Scr mammo bi incl cad 13 A 77067 C I1C 1 0200104012018010120171231N G0202002004computer-aided detection (cad) when performed G0204001003Diagnostic mammography, including computer-aided detection (cad) when Dx mammo incl cad bi 13 A 77066 C I1C 4 0200104012018010120171231N G0204002004performed; bilateral G0206001003Diagnostic mammography, including computer-aided detection (cad) when Dx mammo incl cad uni 13 A 77065 C I1C 4 0200104012018010120171231N G0206002004performed; unilateral 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 D 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 at G0247004004least 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 D 0107I1F 4 0200204012015010120141231N 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; arthrography 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 G0276001003Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar Pild/placebo control clin tr13 A DYY20150101 0193P6D 1 02015010120150101 N G0276002004decompression (pild) or placebo-control, performed in an approved coverage with G0276003004evidence development (ced) clinical trial G0277001003Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval Hbot, full body chamber, 30m13 A35-10 D 0200P5E 1 02015010120150101 N 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) G0279001003Diagnostic digital breast tomosynthesis, unilateral or bilateral (list Tomosynthesis, mammo 13 A C I1C 4 02015010120180101 N G0279002004separately in addition to 77065 or 77066) 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 G0281003004stasis 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 (chondroplasty) at the time of other G0289003004surgical knee arthroscopy in a different compartment of the same knee 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 G0296001003Counseling visit to discuss need for lung cancer screening using low dose ct Visit to determ ldct elig 13 A C M6 1 02015020520150205 N G0296002004scan (ldct) (service is for eligibility determination and shared decision G0296003004making) G0297001003Low dose ct scan (ldct) for lung cancer screening Ldct for lung ca screen 13 A C I2B 1 02015020520150205 N G0299001003Direct skilled nursing services of a registered nurse (rn) in the home health Hhs/hospice of rn ea 15 min 00 9 C M5D 1 02015110220151102 N G0299002004or hospice setting, each 15 minutes G0300001003Direct skilled nursing services of a licensed practical nurse (lpn) in the home Hhs/hospice of lpn ea 15 min00 9 C M5D 1 02015110220151102 N G0300002004health or hospice setting, each 15 minutes 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 C P5E 1 02004010120140101 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 C P5E 1 02004010120140101 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 C P6C 2 0200501012018010120171231N 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 0200701012017010120161231N 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 G0396001003Alcohol and/or substance (other than tobacco) abuse structured assessment Alcohol/subs interv 15-30mn 11 A C M5D 1 02008010120080101 N G0396002004(e.g., audit, dast), and brief intervention 15 to 30 minutes G0397001003Alcohol and/or substance (other than tobacco) abuse structured assessment Alcohol/subs interv >30 min 11 A C M5D 1 02008010120080101 N G0397002004(e.g., 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 Prostate biopsy, any mthd 13 A 610 C T1G 5 02009010120150101 N G0416002004biopsy, any method G0417001003Surgical pathology, gross and microscopic examination, for prostate needle Sat biopsy prostate 21-40 13 A 610 C T1G 5 0200901012015010120141231N G0417002004biopsy, any method, 21-40 specimens G0418001003Surgical pathology, gross and microscopic examination, for prostate needle Sat biopsy prostate 41-60 13 A 610 C T1G 5 0200901012015010120141231N G0418002004biopsy, any method, 41-60 specimens G0419001003Surgical pathology, gross and microscopic examination, for prostate needle Sat biopsy prostate: >60 13 A 610 C T1G 5 0200901012015010120141231N G0419002004biopsy, any method, >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 CYY20170101 P6A 1 02010032320170101 N G0429002004(lds) (e.g., as a result of highly active antiretroviral therapy) G0431001003Drug screen, qualitative; multiple drug classes by high complexity test method Drug screen multiple class 1321 A 340 C T1H 5 0201001012016010120151231N 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 N 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 0201101012016010120151231N 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 9940699407 C P5E 1 0201101012016100120160930N 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 9940699407 C P5E 1 0201101012016100120160930N 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 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 C Y1 2 02012010120140101 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 N G0453001003Continuous intraoperative neurophysiology monitoring, from outside the Cont intraop neuro monitor 13 A C T2D 1 02013010120130101 N 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 N 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 N 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 0201301012015010120141231N 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 0201301012015010120141231N 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 C 0185P7A 6 02013010120180101 N G0459001003Inpatient telehealth pharmacologic management, including prescription, use, and Telehealth inpt pharm mgmt 13 A C M5D 1 02012080220120802 N G0459002004review of medication with no more than minimal medical psychotherapy G0460001003Autologous platelet rich plasma for chronic wounds/ulcers, including Autologous prp for ulcers 13 A C P5E 1 02012080220120802 N G0460002004phlebotomy, centrifugation, and all other preparatory procedures, G0460003004administration and dressings, per treatment G0461001003Immunohistochemistry or immunocytochemistry, per specimen; first single or Immunohisto/cyto chem 1st st13 A 220610 C T1G 5 0201401012015010120141231N G0461002004multiplex antibody stain G0462001003Immunohistochemistry or immunocytochemistry, per specimen; each additional Immunohisto/cyto chem add 13 A 220610 C T1G 5 0201401012015010120141231N G0462002004single or multiplex antibody stain (list separately in addition to code for G0462003004primary procedure) G0463001003Hospital outpatient clinic visit for assessment and management of a patient Hospital outpt clinic visit 00 9 C M1B 1 02014010120140101 N G0464001003Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., Colorec ca scr, sto bas dna 21 A 220310900 81528 C T1H 5 0201410092016010120151231N G0464002004kras, ndrg4 and bmp3) G0466001003Federally qualified health center (fqhc) visit, new patient; a Fqhc visit new patient 13 A C M1A 1 02014100120141001 N G0466002004medically-necessary, face-to-face encounter (one-on-one) between a new patient G0466003004and a fqhc practitioner during which time one or more fqhc services are G0466004004rendered and includes a typical bundle of medicare-covered services that would G0466005004be furnished per diem to a patient receiving a fqhc visit G0467001003Federally qualified health center (fqhc) visit, established patient; a Fqhc visit, estab pt 13 A C M1B 1 02014100120141001 N G0467002004medically-necessary, face-to-face encounter (one-on-one) between an established G0467003004patient and a fqhc practitioner during which time one or more fqhc services are G0467004004rendered and includes a typical bundle of medicare-covered services that would G0467005004be furnished per diem to a patient receiving a fqhc visit G0468001003Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that Fqhc visit, ippe or awv 13 A C M1B 1 02014100120141001 N G0468002004includes an initial preventive physical examination (ippe) or annual wellness G0468003004visit (awv) and includes a typical bundle of medicare-covered services that G0468004004would be furnished per diem to a patient receiving an ippe or awv G0469001003Federally qualified health center (fqhc) visit, mental health, new patient; a Fqhc visit, mh new pt 13 A C M1A 1 02014100120141001 N G0469002004medically-necessary, face-to-face mental health encounter (one-on-one) between G0469003004a new patient and a fqhc practitioner during which time one or more fqhc G0469004004services are rendered and includes a typical bundle of medicare-covered G0469005004services that would be furnished per diem to a patient receiving a mental G0469006004health visit G0470001003Federally qualified health center (fqhc) visit, mental health, established Fqhc visit, mh estab pt 13 A C M1B 1 02014100120141001 N G0470002004patient; a medically-necessary, face-to-face mental health encounter G0470003004(one-on-one) between an established patient and a fqhc practitioner during G0470004004which time one or more fqhc services are rendered and includes a typical bundle G0470005004of medicare-covered services that would be furnished per diem to a patient G0470006004receiving a mental health visit G0471001003Collection of venous blood by venipuncture or urine sample by catheterization Ven blood coll snf/hha 21 A C Z2 5 02014040120140401 N G0471002004from an individual in a skilled nursing facility (snf) or by a laboratory on G0471003004behalf of a home health agency (hha) G0472001003Hepatitis c antibody screening, for individual at high risk and other covered Hep c screen high risk/other1321 A 1861SSA 220 D 0199P5E 5 02014060220160101 N G0472002004indication(s) G0473001003Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Group behave couns 2-10 13 A C M1B 1 02015010120150101 N G0475001003Hiv antigen/antibody, combination assay, screening Hiv combination assay 13 A 140220 C T2D 5 02015041320150413 N G0476001003Infectious agent detection by nucleic acid (dna or rna); human papillomavirus Hpv combo assay ca screen 13 A 140 C T2D 5 02015070920150709 N G0476002004(hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, G047600300468) for cervical cancer screening, must be performed in addition to pap test G0477001003Drug test(s), presumptive, any number of drug classes; any number of devices or Drug test presump optical 21 A 80305 C T1H 5 0201601012017010120161231N G0477002004procedures, (e.g., immunoassay) capable of being read by direct optical G0477003004observation only (e.g., dipsticks, cups, cards, cartridges), includes sample G0477004004validation when performed, per date of service G0478001003Drug test(s), presumptive, any number of drug classes; any number of devices or Drug test presump opt inst 21 A 80306 C T1H 5 0201601012017010120161231N G0478002004procedures, (e.g., immunoassay) read by instrument-assisted direct optical G0478003004observation (e.g., dipsticks, cups, cards, cartridges), includes sample G0478004004validation when performed, per date of service G0479001003Drug test(s), presumptive, any number of drug classes; any number of devices or Drug test presump not opt 21 A 80307 C T1H 5 0201601012017010120161231N G0479002004procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme G0479003004assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes G0479004004sample validation when performed, per date of service G0480001003Drug test(s), definitive, utilizing (1) drug identification methods able to Drug test def 1-7 classes 21 A 340 C T1H 5 02016010120170101 N G0480002004identify individual drugs and distinguish between structural isomers (but not G0480003004necessarily stereoisomers), including, but not limited to gc/ms (any type, G0480004004single or tandem) and lc/ms (any type, single or tandem and excluding G0480005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., G0480006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized G0480007004internal standards in all samples (e.g., to control for matrix effects, G0480008004interferences and variations in signal strength), and (3) method or G0480009004drug-specific calibration and matrix-matched quality control material (e.g., to G0480010004control for instrument variations and mass spectral drift); qualitative or G0480011004quantitative, all sources, includes specimen validity testing, per day; 1-7 G0480012004drug class(es), including metabolite(s) if performed G0481001003Drug test(s), definitive, utilizing (1) drug identification methods able to Drug test def 8-14 classes 21 A 340 C T1H 5 02016010120170101 N G0481002004identify individual drugs and distinguish between structural isomers (but not G0481003004necessarily stereoisomers), including, but not limited to gc/ms (any type, G0481004004single or tandem) and lc/ms (any type, single or tandem and excluding G0481005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., G0481006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized G0481007004internal standards in all samples (e.g., to control for matrix effects, G0481008004interferences and variations in signal strength), and (3) method or G0481009004drug-specific calibration and matrix-matched quality control material (e.g., to G0481010004control for instrument variations and mass spectral drift); qualitative or G0481011004quantitative, all sources, includes specimen validity testing, per day; 8-14 G0481012004drug class(es), including metabolite(s) if performed G0482001003Drug test(s), definitive, utilizing (1) drug identification methods able to Drug test def 15-21 classes 21 A 340 C T1H 5 02016010120170101 N G0482002004identify individual drugs and distinguish between structural isomers (but not G0482003004necessarily stereoisomers), including, but not limited to gc/ms (any type, G0482004004single or tandem) and lc/ms (any type, single or tandem and excluding G0482005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., G0482006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized G0482007004internal standards in all samples (e.g., to control for matrix effects, G0482008004interferences and variations in signal strength), and (3) method or G0482009004drug-specific calibration and matrix-matched quality control material (e.g., to G0482010004control for instrument variations and mass spectral drift); qualitative or G0482011004quantitative, all sources, includes specimen validity testing, per day; 15-21 G0482012004drug class(es), including metabolite(s) if performed G0483001003Drug test(s), definitive, utilizing (1) drug identification methods able to Drug test def 22+ classes 21 A 340 C T1H 5 02016010120170101 N G0483002004identify individual drugs and distinguish between structural isomers (but not G0483003004necessarily stereoisomers), including, but not limited to gc/ms (any type, G0483004004single or tandem) and lc/ms (any type, single or tandem and excluding G0483005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., G0483006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized G0483007004internal standards in all samples (e.g., to control for matrix effects, G0483008004interferences and variations in signal strength), and (3) method or G0483009004drug-specific calibration and matrix-matched quality control material (e.g., to G0483010004control for instrument variations and mass spectral drift); qualitative or G0483011004quantitative, all sources, includes specimen validity testing, per day; 22 or G0483012004more drug class(es), including metabolite(s) if performed G0490001003Face-to-face home health nursing visit by a rural health clinic (rhc) or Home visit rn, lpn by rhc/fq13 A C M4A 1 02016040120160401 N G0490002004federally qualified health center (fqhc) in an area with a shortage of home G0490003004health agencies; (services limited to rn or lpn only) G0491001003Dialysis procedure at a medicare certified esrd facility for acute kidney Dialysis acu kidney no esrd 13 A C P9A 1 02017010120170101 N G0491002004injury without esrd G0492001003Dialysis procedure with single evaluation by a physician or other qualified Md/oth eval acut kid no esrd13 A C P9A 1 02017010120170101 N G0492002004health care professional for acute kidney injury without esrd G0493001003Skilled services of a registered nurse (rn) for the observation and assessment Rn care ea 15 min hh/hospice00 9 C Y2 1 02017010120170101 N G0493002004of the patient's condition, each 15 minutes (the change in the patient's G0493003004condition requires skilled nursing personnel to identify and evaluate the G0493004004patient's need for possible modification of treatment in the home health or G0493005004hospice setting) G0494001003Skilled services of a licensed practical nurse (lpn) for the observation and Lpn care ea 15min hh/hospice00 9 C Y2 1 02017010120170101 N G0494002004assessment of the patient's condition, each 15 minutes (the change in the G0494003004patient's condition requires skilled nursing personnel to identify and evaluate G0494004004the patient's need for possible modification of treatment in the home health or G0494005004hospice setting) G0495001003Skilled services of a registered nurse (rn), in the training and/or education Rn care train/edu in hh 00 9 C Y2 1 02017010120170101 N G0495002004of a patient or family member, in the home health or hospice setting, each 15 G0495003004minutes G0496001003Skilled services of a licensed practical nurse (lpn), in the training and/or Lpn care train/edu in hh 00 9 C Y2 1 02017010120170101 N G0496002004education of a patient or family member, in the home health or hospice setting, G0496003004each 15 minutes G0498001003Chemotherapy administration, intravenous infusion technique; initiation of Chemo extend iv infus w/pump13 A C P7B 1 02016010120160101 N G0498002004infusion in the office/clinic setting using office/clinic pump/supplies, with G0498003004continuation of the infusion in the community setting (e.g., home, domiciliary, G0498004004rest home or assisted living) using a portable pump provided by the G0498005004office/clinic, includes follow up office/clinic visit at the conclusion of the G0498006004infusion G0499001003Hepatitis b screening in non-pregnant, high risk individual includes hepatitis Hepb screen high risk indiv 13 A 140220 C T1H 5 02016092820180401 C G0499002004b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to G0499003004hepatitis b core antigen (anti-hbc), and is followed by a neutralizing G0499004004confirmatory test, when performed, only for an initially reactive hbsag result G0500001003Moderate sedation services provided by the same physician or other qualified Mod sedat endo service >5yrs13 A C P0 1 02017010120170101 N G0500002004health care professional performing a gastrointestinal endoscopic service that G0500003004sedation supports, requiring the presence of an independent trained observer to G0500004004assist in the monitoring of the patient's level of consciousness and G0500005004physiological status; initial 15 minutes of intra-service time; patient age 5 G0500006004years or older (additional time may be reported with 99153, as appropriate) G0501001003Resource-intensive services for patients for whom the use of specialized Resource-inten svc during ov13 A C M5D 1 02017010120170101 N G0501002004mobility-assistive technology (such as adjustable height chairs or tables, G0501003004patient lift, and adjustable padded leg supports) is medically necessary and G0501004004used during the provision of an office/outpatient, evaluation and management G0501005004 visit (list separately in addition to primary service) G0502001003Initial psychiatric collaborative care management, first 70 minutes in the Init psych care manag, 70min13 A 99492 C M5D 1 0201701012018010120171231N G0502002004first calendar month of behavioral health care manager activities, in G0502003004consultation with a psychiatric consultant, and directed by the treating G0502004004physician or other qualified health care professional, with the following G0502005004required elements: outreach to and engagement in treatment of a patient G0502006004directed by the treating physician or other qualified health care professional; G0502007004initial assessment of the patient, including administration of validated rating G0502008004scales, with the development of an individualized treatment plan; review by G0502009004the psychiatric consultant with modifications of the plan if recommended; G0502010004entering patient in a registry and tracking patient follow-up and progress G0502011004using the registry, with appropriate documentation, and participation in weekly G0502012004caseload consultation with the psychiatric consultant; and provision of brief G0502013004interventions using evidence-based techniques such as behavioral activation, G0502014004motivational interviewing, and other focused treatment strategies G0503001003Subsequent psychiatric collaborative care management, first 60 minutes in a Subseq psych care man,60mi 13 A 99493 C M5D 1 0201701012018010120171231N G0503002004subsequent month of behavioral health care manager activities, in consultation G0503003004with a psychiatric consultant, and directed by the treating physician or other G0503004004qualified health care professional, with the following required elements: G0503005004tracking patient follow-up and progress using the registry, with appropriate G0503006004documentation; participation in weekly caseload consultation with the G0503007004psychiatric consultant; ongoing collaboration with and coordination of the G0503008004patient's mental health care with the treating physician or other qualified G0503009004health care professional and any other treating mental health providers; G0503010004additional review of progress and recommendations for changes in treatment, as G0503011004indicated, including medications, based on recommendations provided by the G0503012004psychiatric consultant; provision of brief interventions using evidence-based G0503013004techniques such as behavioral activation, motivational interviewing, and other G0503014004focused treatment strategies; monitoring of patient outcomes using validated G0503015004rating scales; and relapse prevention planning with patients as they achieve G0503016004remission of symptoms and/or other treatment goals and are prepared for G0503017004discharge from active treatment G0504001003Initial or subsequent psychiatric collaborative care management, each Init/sub psych care add 30 m13 A 99494 C M5D 1 0201701012018010120171231N G0504002004additional 30 minutes in a calendar month of behavioral health care manager G0504003004activities, in consultation with a psychiatric consultant, and directed by the G0504004004treating physician or other qualified health care professional (list separately G0504005004in addition to code for primary procedure); (use g0504 in conjunction with G0504006004g0502, g0503) G0505001003Cognition and functional assessment using standardized instruments with Cog/func assessment outpt 13 A 99483 C M5D 1 0201701012018010120171231N G0505002004development of recorded care plan for the patient with cognitive impairment, G0505003004history obtained from patient and/or caregiver, in office or other outpatient G0505004004setting or home or domiciliary or rest home G0506001003Comprehensive assessment of and care planning for patients requiring chronic Comp asses care plan ccm svc13 A C M5D 1 02017010120170101 N G0506002004care management services (list separately in addition to primary monthly care G0506003004management service) G0507001003Care management services for behavioral health conditions, at least 20 minutes Care manage serv minimum 20 13 A 99484 C M5D 1 0201701012018010120171231N G0507002004of clinical staff time, directed by a physician or other qualified health care G0507003004professional, per calendar month, with the following required elements: initial G0507004004assessment or follow-up monitoring, including the use of applicable validated G0507005004rating scales; behavioral health care planning in relation to G0507006004behavioral/psychiatric health problems, including revision for patients who are G0507007004not progressing or whose status changes; facilitating and coordinating G0507008004treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric G0507009004consultation; and continuity of care with a designated member of the care team G0508001003Telehealth consultation, critical care, initial , physicians typically spend 60 Crit care telehea consult 6013 A C M5D 1 02017010120170101 N G0508002004minutes communicating with the patient and providers via telehealth G0509001003Telehealth consultation, critical care, subsequent, physicians typically spend Crit care telehea consult 5013 A C M5D 1 02017010120170101 N G050900200450 minutes communicating with the patient and providers via telehealth G0511001003Rural health clinic or federally qualified health center (rhc or fqhc) only, Ccm/bhi by rhc/fqhc 20min mo13 A D 0214M5D 1 02018010120180101 N G0511002004general care management, 20 minutes or more of clinical staff time for chronic G0511003004care management services or behavioral health integration services directed by G0511004004an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month G0512001003Rural health clinic or federally qualified health center (rhc/fqhc) only, Cocm by rhc/fqhc 60 min mo 13 A D 0214M5D 1 02018010120180101 N G0512002004psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of G0512003004clinical staff time for psychiatric cocm services directed by an rhc or fqhc G0512004004practitioner (physician, np, pa, or cnm) and including services furnished by a G0512005004behavioral health care manager and consultation with a psychiatric consultant, G0512006004per calendar month G0513001003Prolonged preventive service(s) (beyond the typical service time of the primary Prolong prev svcs, first 30m13 A C M5D 1 02018010120180101 N G0513002004procedure), in the office or other outpatient setting requiring direct patient G0513003004contact beyond the usual service; first 30 minutes (list separately in addition G0513004004to code for preventive service) G0514001003Prolonged preventive service(s) (beyond the typical service time of the primary Prolong prev svcs, addl 30m 13 A C M5D 1 02018010120180101 N G0514002004procedure), in the office or other outpatient setting requiring direct patient G0514003004contact beyond the usual service; each additional 30 minutes (list separately G0514004004in addition to code g0513 for additional 30 minutes of preventive service) G0515001003Development of cognitive skills to improve attention, memory, problem solving Cognitive skills development11 A C M5D 1 02018010120180101 N G0515002004(includes compensatory training), direct (one-on-one) patient contact, each 15 G0515003004minutes G0516001003Insertion of non-biodegradable drug delivery implants, 4 or more (services for Insert drug del implant, >=413 A C P6C 1 02018010120180401 S G0516002004subdermal rod implant) G0517001003Removal of non-biodegradable drug delivery implants, 4 or more (services for Remove drug implant 13 A C P6C 1 02018010120180101 N G0517002004subdermal implants) G0518001003Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more Remove w insert drug implant13 A C P6C 1 02018010120180101 N G0518002004(services for subdermal implants) G0659001003Drug test(s), definitive, utilizing drug identification methods able to Drug test def simple all cl 21 A 340 C T1H 5 02017010120170101 N G0659002004identify individual drugs and distinguish between structural isomers (but not G0659003004necessarily stereoisomers), including but not limited to gc/ms (any type, G0659004004single or tandem) and lc/ms (any type, single or tandem), excluding G0659005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., G0659006004alcohol dehydrogenase), performed without method or drug-specific calibration, G0659007004without matrix-matched quality control material, or without use of stable G0659008004isotope or other universally recognized internal standard(s) for each drug, G0659009004drug metabolite or drug class per specimen; qualitative or quantitative, all G0659010004sources, includes specimen validity testing, per day, any number of drug classes G0908001003Most recent hemoglobin (hgb) level > 12.0 g/dl Hgb > 12 g/dl 00 9 C M5D 1 0201201012015010120141231N G0909001003Hemoglobin level measurement not documented, reason not given Hbg not doc 00 9 C M5D 1 0201201012015010120141231N G0910001003Most recent hemoglobin level <= 12.0 g/dl Hgb <= 12 g/dl 00 9 C M5D 1 0201201012015010120141231N 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 0201201012015010120141231N 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 0201201012015010120141231N G0921001003Documentation of patient reason(s) for not being able to assess (e.g., patient Doc pt reas no assess 00 9 C M5D 1 0201201012015010120141231N G0921002004refuses 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 0201201012015010120141231N G0922002004given G2000001003Blinded administration of convulsive therapy procedure, either Blinded conv. tx mdd clin tr00 9 C P6D 1 02018080120180801 A G2000002004electroconvulsive therapy (ect, current covered gold standard) or magnetic G2000003004seizure therapy (mst, non-covered experimental therapy), performed in an G2000004004approved ide-based clinical trial, per treatment session G2010001003Remote evaluation of recorded video and/or images submitted by an established Remot image submit by pt 13 A C M5D 1 02019010120190101 A G2010002004patient (e.g., store and forward), including interpretation with follow-up with G2010003004the patient within 24 business hours, not originating from a related e/m G2010004004service provided within the previous 7 days nor leading to an e/m service or G2010005004procedure within the next 24 hours or soonest available appointment G2011001003Alcohol and/or substance (other than tobacco) abuse structured assessment Alcohol/sub abuse assess 13 A C M1B 1 02019010120190101 A G2011002004(e.g., audit, dast), and brief intervention, 5-14 minutes G2012001003Brief communication technology-based service, e.g. virtual check-in, by a Brief check in by md/qhp 13 A C M5D 1 02019010120190101 A G2012002004physician or other qualified health care professional who can report evaluation G2012003004and management services, provided to an established patient, not originating G2012004004from a related e/m service provided within the previous 7 days nor leading to G2012005004an e/m service or procedure within the next 24 hours or soonest available G2012006004appointment; 5-10 minutes of medical discussion G3001001003Administration and supply of tositumomab, 450 mg Admin + supply, tositumomab 13 A C T2D 1 0200307012017010120161231N G6001001003Ultrasonic guidance for placement of radiation therapy fields Echo guidance radiotherapy 13 A50-7 D I3F 6 02015010120150101 N G6002001003Stereoscopic x-ray guidance for localization of target volume for the delivery Stereoscopic x-ray guidance 13 A C I4B 6 02015010120150101 N G6002002004of radiation therapy G6003001003Radiation treatment delivery, single treatment area,single port or parallel Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6003002004opposed ports, simple blocks or no blocks: up to 5 mev G6004001003Radiation treatment delivery, single treatment area,single port or parallel Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6004002004opposed ports, simple blocks or no blocks: 6-10 mev G6005001003Radiation treatment delivery, single treatment area,single port or parallel Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6005002004opposed ports, simple blocks or no blocks: 11-19 mev G6006001003Radiation treatment delivery, single treatment area,single port or parallel Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6006002004opposed ports, simple blocks or no blocks: 20 mev or greater G6007001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6007002004single treatment area, use of multiple blocks: up to 5 mev G6008001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6008002004single treatment area, use of multiple blocks: 6-10 mev G6009001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6009002004single treatment area, use of multiple blocks: 11-19 mev G6010001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6010002004single treatment area, use of multiple blocks: 20 mev or greater G6011001003Radiation treatment delivery,3 or more separate treatment areas, custom Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6011002004blocking, tangential ports, wedges, rotational beam, compensators, electron G6011003004beam; up to 5 mev G6012001003Radiation treatment delivery,3 or more separate treatment areas, custom Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6012002004blocking, tangential ports, wedges, rotational beam, compensators, electron G6012003004beam; 6-10 mev G6013001003Radiation treatment delivery,3 or more separate treatment areas, custom Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6013002004blocking, tangential ports, wedges, rotational beam, compensators, electron G6013003004beam; 11-19 mev G6014001003Radiation treatment delivery,3 or more separate treatment areas, custom Radiation treatment delivery13 A C P7A 6 02015010120150101 N G6014002004blocking, tangential ports, wedges, rotational beam, compensators, electron G6014003004beam; 20 mev or greater G6015001003Intensity modulated treatment delivery, single or multiple fields/arcs,via Radiation tx delivery imrt 13 A C P7A 6 02015010120150101 N G6015002004narrow spatially and temporally modulated beams, binary, dynamic mlc, per G6015003004treatment session G6016001003Compensator-based beam modulation treatment delivery of inverse planned Delivery comp imrt 13 A C P7A 6 02015010120150101 N G6016002004treatment using 3 or more high resolution (milled or cast) compensator, G6016003004convergent beam modulated fields, per treatment session G6017001003Intra-fraction localization and tracking of target or patient motion during Intrafraction track motion 13 A C P6C 6 02015010120150101 N G6017002004delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface G6017003004tracking), each fraction of treatment G6018001003Ileoscopy, through stoma; with transendoscopic stent placement (includes Ileoscopy w/stent 13 A C P8I 2 0201501012016010120151231N G6018002004predilation) G6019001003Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other Colonoscopy lesion removal 13 A C P8D 2 0201501012016010120151231N G6019002004lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or G6019003004snare technique G6020001003Colonoscopy through stoma; with transendoscopic stent placement (includes Colonoscopy w/stent 13 A C P8D 2 0201501012016010120151231N G6020002004predilation) G6021001003Unlisted procedure, intestine Unlisted px small intestine 13 A C P1G 2 0201501012016010120151231N G6022001003Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other Sigmoidoscopy w/ablate tumr 13 A C P8C 2 0201501012016010120151231N G6022002004lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or G6022003004snare technique G6023001003Sigmoidoscopy, flexible; with transendoscopic stent placement (includes Sigmoidoscopy w/stent 13 A C P8C 2 0201501012016010120151231N G6023002004predilation) G6024001003Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), Lesion removal colonoscopy 13 A C P8D 2 0201501012016010120151231N G6024002004polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, G6024003004bipolar cautery or snare technique G6025001003Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent Colonoscopy w/stent 13 A C P8D 2 0201501012016010120151231N G6025002004placement (includes predilation) G6027001003Anoscopy, high resolution (hra) (with magnification and chemical agent Anoscopy hra w/spec collect 13 A C P5E 2 0201501012016010120151231N G6027002004enhancement); diagnostic, including collection of specimen(s) by brushing or G6027003004washing when performed G6028001003Anoscopy, high resolution (hra) (with magnification and chemical agent Anoscopy hra w/biopsy 13 A C P5E 2 0201501012016010120151231N G6028002004enhancement); with biopsy(ies) G6030001003Amitriptyline Assay of amitriptyline 21 A 340 C T1H 5 0201501012016010120151231N G6031001003Benzodiazepines Assay of benzodiazepines 21 A 340 C T1H 5 0201501012016010120151231N G6032001003Desipramine Assay of desipramine 21 A 340 C T1H 5 0201501012016010120151231N G6034001003Doxepin Assay of doxepin 21 A 340 C T1H 5 0201501012016010120151231N G6035001003Gold Assay of gold 21 A 340 C T1H 5 0201501012016010120151231N G6036001003Assay of imipramine Assay of imipramine 21 A 340 C T1H 5 0201501012016010120151231N G6037001003Nortriptyline Assay of nortiptyline 21 A 340 C T1H 5 0201501012016010120151231N G6038001003Salicylate Assay of salicylate 21 A 340 C T1H 5 0201501012016010120151231N G6039001003Acetaminophen Assay of acetaminophen 21 A 340 C T1H 5 0201501012016010120151231N G6040001003Alcohol (ethanol); any specimen except breath Assay of ethanol 21 A 340 C T1H 5 0201501012016010120151231N G6041001003Alkaloids, urine, quantitative Assay of urine alkaloids 21 A 340 C T1H 5 0201501012016010120151231N G6042001003Amphetamine or methamphetamine Assay of amphetamines 21 A 340 C T1H 5 0201501012016010120151231N G6043001003Barbiturates, not elsewhere specified Assay of barbiturates 21 A 340 C T1H 5 0201501012016010120151231N G6044001003Cocaine or metabolite Assay of cocaine 21 A 340 C T1H 5 0201501012016010120151231N G6045001003Dihydrocodeinone Assay of dihydrocodeinone 21 A 340 C T1H 5 0201501012016010120151231N G6046001003Dihydromorphinone Assay of dihydromorphinone 21 A 340 C T1H 5 0201501012016010120151231N G6047001003Dihydrotestosterone Assay of dihydrotestosterone21 A 330 C T1H 5 0201501012016010120151231N G6048001003Dimethadione Assay of dimethadione 21 A 340 C T1H 5 0201501012016010120151231N G6049001003Epiandrosterone Asssay of epiandrosterone 21 A 330 C T1H 5 0201501012016010120151231N G6050001003Ethchlorvynol Assay of ethchlorvynol 21 A 340 C T1H 5 0201501012016010120151231N G6051001003Flurazepam Assay of flurazepam 21 A 340 C T1H 5 0201501012016010120151231N G6052001003Meprobamate Assay of meprobamate 21 A 340 C T1H 5 0201501012016010120151231N G6053001003Methadone Assay of methadone 21 A 340 C T1H 5 0201501012016010120151231N G6054001003Methsuximide Assay of methsuximide 21 A 340 C T1H 5 0201501012016010120151231N G6055001003Nicotine Assay of nicotine 21 A 340 C T1H 5 0201501012016010120151231N G6056001003Opiate(s), drug and metabolites, each procedure Assay of opiates 21 A 340 C T1H 5 0201501012016010120151231N G6057001003Phenothiazine Assay of phenothiazine 21 A 340 C T1H 5 0201501012016010120151231N G6058001003Drug confirmation, each procedure Drug confirmation 21 A 340 C T1H 5 0201501012016010120151231N G8126001003Patient with a diagnosis of major depression documented as being treated with Pt treat w/antidepress12wks 00 9 C M5D 1 0200601012015010120141231N G8126002004antidepressant medication during the entire 84 day (12 week) acute treatment G8126003004phase G8127001003Patient with a diagnosis of major depression not documented as being treated Pt not treat w/antidepres12w00 9 C M5D 1 0200601012015010120141231N G8127002004with antidepressant medication during the entire 84 day (12 week) acute G8127003004treatment phase G8128001003Clinician documented that patient was not an eligible candidate for Pt inelig for antidepres med00 9 C M5D 1 0200601012015010120141231N G8128002004antidepressant medication during the entire 12 week acute treatment phase G8128003004measure 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 documented results of a central dual-energy x-ray absorptiometry Pt w/dxa results document 00 9 C M5D 1 02008010120160101 N G8399002004(dxa) ever being performed G8400001003Patient with central dual-energy x-ray absorptiometry (dxa) results not Pt w/dxa no results doc 00 9 C M5D 1 02008010120160101 N G8400002004documented, reason not given G8401001003Clinician documented that patient was not an eligible candidate for screening Pt inelig osteo screen measu00 9 C M5D 1 0200801012017010120161231N 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 0200801012015010120141231N G8406002004extremity neurological exam 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 G8417001003Bmi is documented above normal parameters and a follow-up plan is documented Calc bmi abv up param f/u 00 9 C M5D 1 02008010120140101 N G8418001003Bmi is documented below normal parameters and a follow-up plan is documented Calc bmi blw low param f/u 00 9 C M5D 1 02008010120140101 N G8419001003Bmi documented outside normal parameters, no follow-up plan documented, no Calc bmi out nrm param nof/u00 9 C M5D 1 02008010120140101 N G8419002004reason given G8420001003Bmi is documented within normal parameters and no follow-up plan is required Calc bmi norm parameters 00 9 C M5D 1 02008010120140101 N G8421001003Bmi not documented and no reason is given Bmi not calculated 00 9 C M5D 1 02008010120140101 N G8422001003Bmi not documented, documentation the patient is not eligible for bmi Pt inelig bmi calculation 00 9 C M5D 1 02008010120140101 N G8422002004calculation G8427001003Eligible clinician attests to documenting in the medical record they obtained, Docrev cur meds by elig clin00 9 C M5D 1 02008010120170101 N G8427002004updated, or reviewed the patient's current medications G8428001003Current list of medications not documented as obtained, updated, or reviewed by Cur meds not document 00 9 C M5D 1 02008010120170101 N G8428002004the eligible clinician, reason not given G8430001003Eligible clinician attests to documenting in the medical record the patient is Ec at doc medrec pt not elig00 9 C M5D 1 02008010120180101 N G8430002004not eligible for a current list of medications being obtained, updated, or G8430003004reviewed by the eligible clinician G8431001003Screening for depression is documented as being positive and a follow-up plan Pos clin depres scrn f/u doc00 9 C M5D 1 02008010120170101 N G8431002004is documented G8432001003Depression screening not documented, reason not given Dep scr not doc, rng 00 9 C M5D 1 02008010120170101 N G8433001003Screening for depression not completed, documented reason Scr for dep not cpt doc rsn 00 9 C M5D 1 02008010120180101 N G8442001003Pain assessment not documented as being performed, documentation the patient is Doc pain as nt perf, not elg00 9 C M5D 1 02008010120180101 N G8442002004not eligible for a pain assessment using a standardized tool at the time of the G8442003004encounter G8450001003Beta-blocker therapy prescribed Beta-bloc rx pt w/abn lvef 00 9 C M5D 1 02008010120130101 N G8451001003Beta-blocker therapy for lvef < 40% not prescribed for reasons documented by Pt w/abn lvef inelig b-bloc 00 9 C M5D 1 02008010120140101 N G8451002004the clinician (e.g., low blood pressure, fluid overload, asthma, patients G8451003004recently treated with an intravenous positive inotropic agent, allergy, G8451004004intolerance, other medical reasons, patient declined, other patient reasons, or G8451005004other reasons attributable to the healthcare system) G8452001003Beta-blocker therapy not prescribed Pt w/abn lvef b-bloc no rx 00 9 C M5D 1 02008010120130101 N G8458001003Clinician documented that patient is not an eligible candidate for genotype Pt inelig geno no antvir tx 00 9 C M5D 1 0200801012017010120161231N G8458002004testing; patient not receiving antiviral treatment for hepatitis c during the G8458003004measurement period (e.g. genotype test done prior to the reporting period, G8458004004patient declines, patient not a candidate for antiviral treatment) G8460001003Clinician documented that patient is not an eligible candidate for quantitative Pt inelig rna no antvir tx 00 9 C M5D 1 0200801012017010120161231N G8460002004rna testing at week 12; patient not receiving antiviral treatment for hepatitis G8460003004c G8461001003Patient receiving antiviral treatment for hepatitis c during the measurement Pt rec antivir treat hep c 00 9 C M5D 1 0200801012017010120161231N G8461002004period G8464001003Clinician documented that prostate cancer patient is not an eligible candidate Pt inelig; lo to no dter rsk00 9 C M5D 1 0200801012015010120141231N G8464002004for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk G8464003004of recurrence not determined G8465001003High or very high risk of recurrence of prostate cancer High risk recurrence pro ca 00 9 C M5D 1 02008010120160101 N 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 02008010120150101 N G8474002004(arb) therapy not prescribed for reasons documented by the clinician (e.g., G8474003004allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases G8474004004of the aortic or mitral valve, other medical reasons) or (e.g., patient G8474005004declined, other patient reasons) or (e.g., lack of drug availability, other G8474006004reasons attributable to the health care system) G8475001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker Ace/arb thxpy not rx'd 00 9 C M5D 1 02008010120130101 N G8475002004(arb) therapy not prescribed, reason not given G8476001003Most recent blood pressure has a systolic measurement of < 140 mmhg and a Bp sys <140 and dias <90 00 9 C M5D 1 02008010120150101 N G8476002004diastolic measurement of < 90 mmhg G8477001003Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a Bp sys>=140 and/or dias >=9000 9 C M5D 1 02008010120150101 N G8477002004diastolic measurement of >= 90 mmhg G8478001003Blood pressure measurement not performed or documented, reason not given Bp not performed/doc 00 9 C M5D 1 02008010120130101 N G8482001003Influenza immunization administered or previously received Flu immunize order/admin 00 9 C M5D 1 02008010120120101 N G8483001003Influenza immunization was not administered for reasons documented by clinician Flu imm no admin doc rea 00 9 C M5D 1 02008010120150101 N G8483002004(e.g., patient allergy or other medical reasons, patient declined or other G8483003004patient reasons, vaccine not available or other system reasons) G8484001003Influenza immunization was not administered, reason not given Flu immunize no admin 00 9 C M5D 1 02008010120150101 N G8485001003I intend to report the diabetes mellitus (dm) measures group Report, diabetes measures 00 9 C M5D 1 0200807012017010120161231N G8486001003I intend to report the preventive care measures group Report, prev care measures 00 9 C M5D 1 0200807012017010120161231N G8487001003I intend to report the chronic kidney disease (ckd) measures group Report ckd measures 00 9 C M5D 1 0200807012017010120161231N G8489001003I intend to report the coronary artery disease (cad) measures group Cad measures grp 00 9 C M5D 1 0200901012017010120161231N G8490001003I intend to report the rheumatoid arthritis (ra) measures group Ra measures grp 00 9 C M5D 1 0200901012017010120161231N G8491001003I intend to report the hiv/aids measures group Hiv/aids measures grp 00 9 C M5D 1 0200901012017010120161231N G8492001003I intend to report the perioperative care measures group Periop care measures grp 00 9 C M5D 1 0200901012015010120141231N G8493001003I intend to report the back pain measures group Back pain measures grp 00 9 C M5D 1 0200901012015010120141231N G8494001003All quality actions for the applicable measures in the diabetes mellitus (dm) Dm meas qual act perform 00 9 C M5D 1 0200901012017010120161231N 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 0200901012017010120161231N 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 0200901012017010120161231N 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 0200901012017010120161231N 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 0200901012017010120161231N 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 0200901012017010120161231N 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 0200901012017010120161231N 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 0200901012015010120141231N 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 0200901012015010120141231N G8502002004have been performed for this patient G8506001003Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin Pt rec ace/arb 00 9 C M5D 1 02009010120090101 N G8506002004receptor blocker (arb) therapy G8509001003Pain assessment documented as positive using a standardized tool, follow-up Pos pain assess no f/u doc 00 9 C M5D 1 02009010120140101 N G8509002004plan not documented, reason not given G8510001003Screening for depression is documented as negative, a follow-up plan is not Scr dep neg, no plan reqd 00 9 C M5D 1 02009010120170101 N G8510002004required G8511001003Screening for depression documented as positive, follow-up plan not documented, Scr dep pos, no plan doc rng00 9 C M5D 1 02009010120170101 N G8511002004reason not given G8530001003Autogenous av fistula received Auto av fistula recd 00 9 C M5D 1 0200901012016010120151231N G8531001003Clinician documented that patient was not an eligible candidate for autogenous Pt inelig; auto av fistula 00 9 C M5D 1 0200901012016010120151231N G8531002004av fistula G8532001003Clinician documented that patient received vascular access other than No auto av fistula; no reas 00 9 C M5D 1 0200901012016010120151231N G8532002004autogenous av fistula, reason not given G8535001003Elder maltreatment screen not documented; documentation that patient is not Eld maltreatment not doc 00 9 C M5D 1 02009010120180101 N G8535002004eligible for the elder maltreatment screen at the time of the encounter G8536001003No documentation of an elder maltreatment screen, reason not given No doc elder mal scrn 00 9 C M5D 1 02009010120130101 N G8539001003Functional outcome assessment documented as positive using a standardized tool Doc funct and care plan 00 9 C M5D 1 02009010120140101 N G8539002004and a care plan based on identified deficiencies on the date of functional G8539003004outcome assessment, is documented G8540001003Functional outcome assessment not documented as being performed, documentation Foa not doc as being perf 00 9 C M5D 1 02009010120180101 N G8540002004the patient is not eligible for a functional outcome assessment using a G8540003004standardized tool at the time of the encounter G8541001003Functional outcome assessment using a standardized tool not documented, reason No doc cur funct assess 00 9 C M5D 1 02009010120130101 N G8541002004not given G8542001003Functional outcome assessment using a standardized tool is documented; no Doc funct no deficiencies 00 9 C M5D 1 02009010120140101 N G8542002004functional deficiencies identified, care plan not required G8543001003Documentation of a positive functional outcome assessment using a standardized Cur funct asses; no care pln00 9 C M5D 1 02009010120140101 N G8543002004tool; care 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 0200901012017010120161231N G8545001003I intend to report the hepatitis c measures group Hepc measures grp 00 9 C M5D 1 0201001012017010120161231N G8547001003I intend to report the ischemic vascular disease (ivd) measures group Ivd measures grp 00 9 C M5D 1 0201001012015010120141231N G8548001003I intend to report the heart failure (hf) measures group Hf measures grp 00 9 C M5D 1 0201001012017010120161231N G8549001003All quality actions for the applicable measures in the hepatitis c measures Hepc mg qual act perform 00 9 C M5D 1 0201001012017010120161231N G8549002004group 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 0201001012017010120161231N 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 0201001012015010120141231N G8552002004disease (ivd) measures group have been performed for this patient 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 N 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 N G8568002004in disorders of the ear) for an otologic evaluation, reason not given G8569001003Prolonged postoperative intubation (> 24 hrs) required Prol intubation req 00 9 C M5D 1 02010010120140101 N G8570001003Prolonged postoperative intubation (> 24 hrs) not required No prol intub req 00 9 C M5D 1 02010010120140101 N G8571001003Development of deep sternal wound infection/mediastinitis within 30 days Ster wd ifx 30 d postop 00 9 C M5D 1 02010010120150101 N G8571002004postoperatively G8572001003No deep sternal wound infection/mediastinitis No ster wd ifx 00 9 C M5D 1 02010010120150101 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 N 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 N G8578002004tamponade, graft occlusion, valve dysfunction or other cardiac reason G8579001003Antiplatelet medication at discharge Antplt med disch 00 9 C M5D 1 0201001012015010120141231N G8580001003Antiplatelet medication contraindicated Antplt med contraind 00 9 C M5D 1 0201001012015010120141231N G8581001003No antiplatelet medication at discharge No antplt med disch 00 9 C M5D 1 0201001012015010120141231N G8582001003Beta-blocker at discharge Bblock disch 00 9 C M5D 1 0201001012015010120141231N G8583001003Beta-blocker contraindicated Bblock contraind 00 9 C M5D 1 0201001012015010120141231N G8584001003No beta-blocker at discharge No bblock disch 00 9 C M5D 1 0201001012015010120141231N G8585001003Anti-lipid treatment at discharge Antilipid treat disch 00 9 C M5D 1 0201001012015010120141231N G8586001003Anti-lipid treatment contraindicated Antlip disch contra 00 9 C M5D 1 0201001012015010120141231N G8587001003No anti-lipid treatment at discharge No antlipid treat disch 00 9 C M5D 1 0201001012015010120141231N G8593001003Lipid profile results documented and reviewed (must include total cholesterol, Lipid pn results 00 9 C M5D 1 0201001012015010120141231N G8593002004hdl-c, triglycerides and calculated ldl-c) G8594001003Lipid profile not performed, reason not given No lipid prof perf 00 9 C M5D 1 0201001012015010120141231N G8595001003Most recent ldl-c < 100 mg/dl Ldl < 100 00 9 C M5D 1 0201001012015010120141231N G8597001003Most recent ldl-c >= 100 mg/dl Ldl >= 100 00 9 C M5D 1 0201001012015010120141231N G8598001003Aspirin or another antiplatelet therapy used Asa/antiplat ther used 00 9 C M5D 1 02010010120170101 N G8599001003Aspirin or another antiplatelet therapy not used, reason not given No asa/antiplat ther use rng00 9 C M5D 1 02010010120170101 N 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 N G8602002004well, reason not given 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 0201101012015010120141231N 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 0201101012015010120141231N 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 0201101012015010120141231N 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 0201101012015010120141231N 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 0201101012017010120161231N G8634002004therapy for osteoporosis G8635001003Pharmacologic therapy for osteoporosis was not prescribed, reason not given No pharm ther osteo rx 00 9 C M5B 1 02011010120130101 N G8645001003I intend to report the asthma measures group Asthma measures grp 00 9 C M5B 1 0201101012017010120161231N G8646001003All quality actions for the applicable measures in the asthma measures group Asthma mg qual act perform 00 9 C M5B 1 0201101012017010120161231N G8646002004have been performed for this patient G8647001003Risk-adjusted functional status change residual score for the knee impairment Rafscrs ki scor >= 0 00 9 C M5B 1 02011010120190101 C G8647002004successfully calculated and the score was equal to zero (0) or greater than G8647003004zero (> 0) G8648001003Risk-adjusted functional status change residual score for the knee impairment Rafscrs ki scor < 0 00 9 C M5B 1 02011010120190101 C G8648002004successfully calculated and the score was less than zero (< 0) G8649001003Risk-adjusted functional status change residual score for the knee impairment Rafscrs ki no scor 00 9 C M5B 1 02011010120190101 C G8649002004not measured because the patient did not complete the fs status survey near G8649003004discharge, patient not appropriate G8650001003Risk-adjusted functional status change residual scores for the knee impairment Rafscrs ki no scor no surv 00 9 C M5B 1 02011010120190101 C G8650002004not measured because the patient did not complete the fs intake survey on G8650003004admission and/or follow up fs status survey near discharge, reason not given G8651001003Risk-adjusted functional status change residual score for the hip impairment Rafscrs hi scor >=0 00 9 C M5B 1 02011010120190101 C G8651002004successfully calculated and the score was equal to zero (0) or greater than G8651003004zero (> 0) G8652001003Risk-adjusted functional status change residual score for the hip impairment Rafscrs hi scor < 0 00 9 C M5B 1 02011010120190101 C G8652002004successfully calculated and the score was less than zero (< 0) G8653001003Risk-adjusted functional status change residual scores for the hip impairment Rafscrs hi no scor 00 9 C M5B 1 02011010120190101 C G8653002004not measured because the patient did not complete the fs status survey near G8653003004discharge, patient not appropriate G8654001003Risk-adjusted functional status change residual score for the hip impairment Rafscrs hi no scor no surv 00 9 C M5B 1 02011010120190101 C G8654002004not measured because the patient did not complete the fs intake survey on G8654003004admission and/or follow up fs status survey near discharge, reason not given G8655001003Risk-adjusted functional status change residual score for the lower leg, foot Rafscrs llfai scor >= 0 00 9 C M5B 1 02011010120190101 C G8655002004or ankle impairment successfully calculated and the score was equal to zero (0) G8655003004or greater than zero ( > 0) G8656001003Risk-adjusted functional status change residual score for the lower leg, foot Rafscrs llfai scor < 0 00 9 C M5B 1 02011010120190101 C G8656002004or ankle impairment successfully calculated and the score was less than zero (< G86560030040) G8657001003Risk-adjusted functional status change residual score for the lower leg, foot Rafscrs llfai no scor 00 9 C M5B 1 02011010120190101 C G8657002004or ankle impairment not measured because the patient did not complete the fs G8657003004status survey near discharge, patient not appropriate G8658001003Risk-adjusted functional status change residual score for the lower leg, foot Rafscrs llfai no scor + surv00 9 C M5B 1 02011010120190101 C G8658002004or ankle impairment not measured because the patient did not complete the fs G8658003004intake survey on admission and/or follow up fs status survey near discharge, G8658004004reason not given G8659001003Risk-adjusted functional status change residual score for the low back Rafscrs lbi scor >= 0 00 9 C M5B 1 02011010120190101 C G8659002004impairment successfully calculated and the score was equal to zero (0) or G8659003004greater than zero (> 0) G8660001003Risk-adjusted functional status change residual score for the low back Rafscrs lbi scor < 0 00 9 C M5B 1 02011010120190101 C G8660002004impairment successfully calculated and the score was less than zero (< 0) G8661001003Risk-adjusted functional status change residual score for the low back Rafscrs lbi no scor 00 9 C M5B 1 02011010120190101 C G8661002004impairment not measured because the patient did not complete the fs status G8661003004survey near discharge, patient not appropriate G8662001003Risk-adjusted functional status change residual score for the low back Rafscrs lbi no scor no surv 00 9 C M5B 1 02011010120190101 C G8662002004impairment not measured because the patient did not complete the fs intake G8662003004survey on admission and/or follow up fs status survey near discharge, reason G8662004004not given G8663001003Risk-adjusted functional status change residual score for the shoulder Rafscrs si scor >= 0 00 9 C M5B 1 02011010120190101 C G8663002004impairment successfully calculated and the score was equal to zero (0) or G8663003004greater than zero (> 0) G8664001003Risk-adjusted functional status change residual score for the shoulder Rafscrs si scor < 0 00 9 C M5B 1 02011010120190101 C G8664002004impairment successfully calculated and the score was less than zero (< 0) G8665001003Risk-adjusted functional status change residual score for the shoulder Rafscrs si no scor 00 9 C M5B 1 02011010120190101 C G8665002004impairment not measured because the patient did not complete the fs status G8665003004survey near discharge, patient not appropriate G8666001003Risk-adjusted functional status change residual score for the shoulder Rafscrs si no scor no surv 00 9 C M5B 1 02011010120190101 C G8666002004impairment not measured because the patient did not complete the fs intake G8666003004survey on admission and/or follow up fs status survey near discharge, reason G8666004004not given G8667001003Risk-adjusted functional status change residual score for the elbow, wrist or Rafscrs ewh scor >= 0 00 9 C M5B 1 02011010120190101 C G8667002004hand impairment successfully calculated and the score was equal to zero (0) or G8667003004greater than zero (> 0) G8668001003Risk-adjusted functional status change residual score for the elbow, wrist or Rafscrs ewh scor < 0 00 9 C M5B 1 02011010120190101 C G8668002004hand impairment successfully calculated and the score was less than zero (< 0) G8669001003Risk-adjusted functional status change residual score for the elbow, wrist or Rafscrs 00 9 C M5B 1 02011010120190101 C G8669002004hand impairment not measured because the patient did not complete the fs status G8669003004survey near discharge, patient not appropriate G8670001003Risk-adjusted functional status change residual score for the elbow, wrist or Rafscrs ewh no scor no surv 00 9 C M5B 1 02011010120190101 C G8670002004hand impairment not measured because the patient did not complete the fs intake G8670003004survey on admission and/or follow up fs status survey near discharge, reason G8670004004not given G8671001003Risk-adjusted functional status change residual score for the neck, cranium, Rafscrs goi scor >= 0 00 9 C M5B 1 02011010120190101 C 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, Rafscrs goi scor < 0 00 9 C M5B 1 02011010120190101 C 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 score for the neck, cranium, Rafscrs goi no scor 00 9 C M5B 1 02011010120190101 C G8673002004mandible, thoracic spine, ribs or other general orthopedic impairment not G8673003004measured because the patient did not complete the fs status survey near G8673004004discharge, patient not appropriate G8674001003Risk-adjusted functional status change residual score for the neck, cranium, Rafscrs neck, no msr/no foto00 9 C M5B 1 02011010120190101 C G8674002004mandible, thoracic spine, ribs or other general orthopedic impairment not G8674003004measured because the patient did not complete the fs status survey on admission G8674004004and/or follow up fs status survey near discharge, reason not given G8682001003Lvf testing documented as being performed prior to discharge or in the previous Lvg test perf 00 9 C M5B 1 0201101012015010120141231N G868200200412 months G8683001003Lvf testing not performed prior to discharge or in the previous 12 months for a Pt not elig for lvf test 00 9 C M5B 1 0201101012015010120141231N G8683002004medical or patient documented reason G8685001003Lvf testing not documented as being performed prior to discharge or in the Lvf test not perf 00 9 C M5B 1 0201101012015010120141231N G8685002004previous 12 months, reason not given G8694001003Left ventricular ejection fraction (lvef) < 40% Lvef <40% 00 9 C M5B 1 02012010120120101 N G8696001003Antithrombotic therapy prescribed at discharge Antithromb thx presc 00 9 C M5B 1 0201201012018010120171231N G8697001003Antithrombotic therapy not prescribed for documented reasons (e.g., patient had Antithromb no presc doc reas00 9 C M5B 1 0201201012018010120171231N G8697002004stroke during hospital stay, patient expired during inpatient stay, other G8697003004medical reason(s)); (e.g., patient left against medical advice, other patient G8697004004reason(s)) G8698001003Antithrombotic therapy was not prescribed at discharge, reason not given Antithromb no presc no reas 00 9 C M5B 1 0201201012018010120171231N G8699001003Rehabilitation services (occupational, physical or speech) ordered at or prior Rehab ordered disch 00 9 C M5B 1 0201201012015010120141231N G8699002004to discharge G8700001003Rehabilitation services (occupational, physical or speech) not indicated at or Rehab not indicated disch 00 9 C M5B 1 0201201012015010120141231N G8700002004prior to discharge G8701001003Rehabilitation services were not ordered, reason not otherwise specified Rehab not ordered 00 9 C M5B 1 0201201012015010120141231N G8702001003Documentation that prophylactic antibiotics were given within 4 hours prior to Antiobiotics 4 hr prior surg00 9 C M5B 1 0201201012015010120141231N G8702002004surgical incision or intraoperatively G8703001003Documentation that prophylactic antibiotics were neither given within 4 hours Antibiotics not prior surg 00 9 C M5B 1 0201201012015010120141231N G8703002004prior to surgical incision nor intraoperatively G870400100312-lead electrocardiogram (ecg) performed Ecg performed 00 9 C M5B 1 0201201012015010120141231N G8705001003Documentation of medical reason(s) for not performing a 12-lead Med reas no ecg 00 9 C M5B 1 0201201012015010120141231N G8705002004electrocardiogram (ecg) G8706001003Documentation of patient reason(s) for not performing a 12-lead Pt reas no ecg 00 9 C M5B 1 0201201012015010120141231N G8706002004electrocardiogram (ecg) G870700100312-lead electrocardiogram (ecg) not performed, reason not given Ecg not performed 00 9 C M5B 1 0201201012015010120141231N 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) Pt presc doc med rsn id uri 00 9 C M5B 1 02012010120190101 C G8709002004within three days after the initial diagnosis of uri (e.g., intestinal G8709003004infection, pertussis, bacterial infection, lyme disease, otitis media, acute G8709004004sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection G8709005004of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, G8709006004or bone infections, acute lymphadenitis, impetigo, skin staph infections, G8709007004pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, G8709008004inflammatory diseases (female reproductive organs)), infections of the kidney, G8709009004cystitis or uti, and acne) 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 0201201012016010120151231N G8713002004volume [v]) G8714001003Hemodialysis treatment performed exactly three times per week for > 90 days Hemodialysis 3 times week 00 9 C M5B 1 0201201012016010120151231N 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 0201201012016010120151231N 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 0201201012016010120151231N 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 0201201012016010120151231N 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 G8722001003Documentation of medical reason(s) for not including the pt category, the pn Med reas pt, pn, not doc 00 9 C M5B 1 02012010120140101 N G8722002004category or the histologic grade in the pathology report (e.g., re-excision G8722003004without residual tumor; non-carcinomasanal 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 N 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 0201201012017010120161231N G8725002004cholesterol) G8726001003Clinician has documented reason for not performing fasting lipid profile (e.g., Doc reas no lipid profile 00 9 C M5B 1 0201201012017010120161231N G8726002004patient declined, other patient reasons) G8728001003Fasting lipid profile not performed, reason not given Lipid profile not perf 00 9 C M5B 1 0201201012017010120161231N G8730001003Pain assessment documented as positive using a standardized tool and a Pain doc pos and plan 00 9 C M5B 1 02012010120140101 N G8730002004follow-up plan is documented G8731001003Pain assessment using a standardized tool is documented as negative, no Pain neg no plan 00 9 C M5B 1 02012010120140101 N G8731002004follow-up plan required G8732001003No documentation of pain assessment, reason not given No doc of pain 00 9 C M5B 1 02012010120130101 N G8733001003Elder maltreatment screen documented as positive and a follow-up plan is Doc pos elder mal scrn plan 00 9 C M5B 1 02012010120140101 N G8733002004documented 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 N G8735002004documented, reason not given G8736001003Most current ldl-c <100mg/dl Ldl-c <100mg/dl 00 9 C M5B 1 0201201012015010120141231N G8737001003Most current ldl-c >=100mg/dl Ldl-c >=100mg/dl 00 9 C M5B 1 0201201012015010120141231N G8738001003Left ventricular ejection fraction (lvef) < 40% or documentation of severely or Lvef < 40% 00 9 C M5B 1 0201201012015010120141231N G8738002004moderately depressed left ventricular systolic function G8739001003Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or Lvef >= 40% 00 9 C M5B 1 0201201012015010120141231N 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 0201201012015010120141231N G8740002004given G8749001003Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs No signs melanoma 00 9 C M5B 1 02012010120190101 C G8749002004such as weakness, or any other sign suggesting systemic spread) or absence of G8749003004symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom G8749004004suggesting 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 0201201012015010120141231N G8751002004reason not given G8752001003Most recent systolic blood pressure < 140 mmhg Sys bp less 140 00 9 C M5B 1 02012010120120101 N G8753001003Most recent systolic blood pressure >= 140 mmhg Sys bp > or = 140 00 9 C M5B 1 02012010120120101 N G8754001003Most recent diastolic blood pressure < 90 mmhg Dias bp less 90 00 9 C M5B 1 02012010120120101 N G8755001003Most recent diastolic blood pressure >= 90 mmhg 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 N G8757001003All quality actions for the applicable measures in the chronic obstructive Copd mg qual act perform 00 9 C M5B 1 0201201012017010120161231N 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 0201201012017010120161231N 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 0201201012017010120161231N G8759002004group have 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 0201201012017010120161231N 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 0201201012017010120161231N 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 0201201012015010120141231N 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 0201201012015010120141231N 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 0201201012017010120161231N 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 0201201012015010120141231N 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 0201201012015010120141231N G8768002004patients with palliative goals 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 0201201012015010120141231N G8770001003Urine protein test result documented and reviewed Urine protein test doc rev 00 9 C M5B 1 0201201012015010120141231N G8771001003Documentation of diagnosis of chronic kidney disease Doc dx ckd 00 9 C M5B 1 0201201012015010120141231N G8772001003Documentation of medical reason(s) for not performing urine protein test (e.g., Doc med reas no urine protn 00 9 C M5B 1 0201201012015010120141231N G8772002004patients with palliative goals 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 0201201012015010120141231N G8774001003Serum creatinine test result documented and reviewed Serum creatinine doc rev 00 9 C M5B 1 0201201012015010120141231N G8775001003Documentation of medical reason(s) for not performing serum creatinine test Doc med reas no serum crtn 00 9 C M5B 1 0201201012015010120141231N G8775002004(e.g., patients with palliative goals 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 0201201012015010120141231N G8777001003Diabetes screening test performed Diabetes screen 00 9 C M5B 1 0201201012015010120141231N G8778001003Documentation of medical reason(s) for not performing diabetes screening test Doc med reas no diabete scrn00 9 C M5B 1 0201201012015010120141231N G8778002004(e.g., patients with a diagnosis of diabetes, or with palliative goals or for G8778003004whom treatment of hypertension with standard treatment goals is not clinically G8778004004appropriate) G8779001003Diabetes screening test not performed, reason not given No diabetes screen 00 9 C M5B 1 0201201012015010120141231N G8780001003Counseling for diet and physical activity performed Counsel diet phys activity 00 9 C M5B 1 0201201012015010120141231N G8781001003Documentation of medical reason(s) for patient not receiving counseling for Doc med reas no counsel diet00 9 C M5B 1 0201201012015010120141231N G8781002004diet and physical activity (e.g., patients with palliative goals or for whom G8781003004treatment 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 0201201012015010120141231N G8783001003Normal blood pressure reading documented, follow-up not required Bp scrn perf rec interval 00 9 C M5B 1 02012010120130101 N G8784001003Patient not eligible (e.g., documentation the patient is not eligible due to Pt no elig for bp assess 00 9 C M5B 1 0201201012017010120161231N G8784002004active diagnosis of hypertension, patient refuses, urgent or emergent situation) G8785001003Blood pressure reading not documented, reason not given Bp scrn no perf at interval 00 9 C M5B 1 02012010120130101 N 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 G8806001003Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy Perf ultrsnd to lct preg doc00 9 C M5B 1 02012010120190101 C G8806002004location documented G8807001003Trans-abdominal or trans-vaginal ultrasound not performed for reasons No ta tv ultrasnd 00 9 C M5B 1 02012010120190101 S G8807002004documented by clinician (e.g., patient has visited the ed multiple times within G880700300472 hours, patient has a documented intrauterine pregnancy [iup]) G8808001003Trans-abdominal or trans-vaginal ultrasound not performed, reason not given Ultrasound not perf, rng 00 9 C M5B 1 02012010120180101 N G8809001003Rh-immunoglobulin (rhogam) ordered Rh-immunoglobulin order 00 9 C M5B 1 02012010120120101 N G8810001003Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician Doc reas no rh-immuno 00 9 C M5B 1 02012010120140101 N G8810002004(e.g., patient had prior documented receipt of rhogam within 12 weeks, patient G8810003004refusal) G8811001003Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given No rh-immunoglobulin order 00 9 C M5B 1 02012010120130101 N G8815001003Documented reason in the medical records for why the statin therapy was not Doc reas no statin therapy 00 9 C M5B 1 02012010120170101 N G8815002004prescribed (i.e., lower extremity bypass was for a patient with G8815003004non-artherosclerotic disease) 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 N 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 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 G8833001003Patient not discharged to home by post-operative day #2 following evar Pt not disch home day#2 evar00 9 C M5B 1 02012010120130101 N 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 G8838001003Patient not discharged to home by post-operative day #2 following cea Not disch home by day #2 00 9 C M5B 1 02012010120130101 N 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 documenting an assessment of sleep symptoms Doc reas no sleep apnea 00 9 C M5B 1 02012010120150101 N G8840002004(e.g., patient didn't have initial daytime sleepiness, patient visited 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 N 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 02012010120150101 N G8843002004respiratory disturbance index (rdi) at the time of initial diagnosis (e.g., G8843003004psychiatric disease, dementia, patient declined, financial, insurance coverage, G8843004004test ordered but not yet completed) G8844001003Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured No ahi or rdi initial dx 00 9 C M5B 1 02012010120130101 N 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) G8848001003Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory Mild osa 00 9 C M5B 1 0201201012017010120161231N 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 N G8849002004(e.g., patient unable to tolerate, alternative therapies use, patient declined, G8849003004financial, insurance coverage) G8850001003Positive airway pressure therapy not prescribed, reason not given No pap prescribed 00 9 C M5B 1 02012010120130101 N 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 0201201012017010120161231N G8854001003Documentation of reason(s) for not objectively measuring adherence to positive Reas no adhere pos air pres 00 9 C M5B 1 02012010120130101 N 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 N 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 G8857002004patients 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 N G8858002004given G8859001003Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or Corticosteroids 10mg 60 days00 9 C M5B 1 0201201012015010120141231N G8859002004greater consecutive days G8860001003Patients who have received dose of corticosteroids greater than or equal to Corticosteroid 10 mg 60 days00 9 C M5B 1 0201201012015010120141231N G886000200410mg/day for 60 or greater consecutive days G8861001003Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered Dxa ordered for osteo 00 9 C M5B 1 02012010120150101 N G8861002004and documented, review of systems and medication history or pharmacologic G8861003004therapy (other than minerals/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 0201201012015010120141231N 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 N 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 N G8868001003Patients receiving a first course of anti-tnf therapy 1st course antitnf 00 9 C M5B 1 0201201012017010120161231N G8869001003Patient has documented immunity to hepatitis b and initiating anti-tnf therapy Doc immune hep b antitnf 00 9 C M5B 1 02012010120180101 N G8870001003Hepatitis b vaccine injection administered or previously received and is Hepb admin 1st antitnf 00 9 C M5B 1 0201201012016010120151231N 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 0201201012016010120151231N 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 N 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 the G8873006004actual 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 02012010120150101 N G8876002004diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, G8876003004chest wall, etc., lesion could not be adequately visualized for needle biopsy, G8876004004patient condition prevents needle biopsy [weight, breast thickness, etc.], duct G8876005004excision without imaging abnormality, prophylactic mastectomy, reduction G8876006004mammoplasty, 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 N 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 0201201012018010120171231N G8880001003Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., Sen lym p node biop not perf00 9 C M5B 1 02012010120190101 C G8880002004reasons could include but not limited to; non-invasive cancer, incidental G8880003004discovery of breast cancer on prophylactic mastectomy, incidental discovery of G8880004004breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node G8880005004(ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, G8880006004recurrent invasive breast cancer, clinically node positive after neoadjuvant G8880007004systemic therapy, patient refusal after informed consent, patient with G8880008004significant age, comorbidities, or limited life expectancy and favorable tumor; G8880009004adjuvant systemic therapy unlikely to change) 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, reason not given No sent lymph node biopsy 00 9 C M5B 1 02012010120140101 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 G8885001003Biopsy 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 0201201012015010120141231N G8887001003Documentation of medical reason(s) for most recent blood pressure not being Doc med reas bp not control 00 9 C M5B 1 0201201012015010120141231N G8887002004under control (e.g., patients with palliative goals or for whom treatment of G8887003004hypertension with standard treatment goals is not clinically appropriate) G8888001003Most recent blood pressure not under control, results documented and reviewed Bp not under control 00 9 C M5B 1 0201201012015010120141231N G8889001003No documentation of blood pressure measurement, reason not given No doc bp 00 9 C M5B 1 0201201012015010120141231N G8890001003Most recent ldl-c under control, results documented and reviewed Ldl-c under control 00 9 C M5B 1 0201201012015010120141231N G8891001003Documentation of medical reason(s) for most recent ldl-c not under control Doc med reas no ldl-c contrl00 9 C M5B 1 0201201012015010120141231N G8891002004(e.g., patients with palliative goals 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. patients Doc med reas no ldl-c test 00 9 C M5B 1 0201201012015010120141231N G8892002004with palliative goals or for whom treatment of hypertension with standard G8892003004treatment 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 0201201012015010120141231N G8894001003Ldl-c not performed, reason not given Ldl-c not performed 00 9 C M5B 1 0201201012015010120141231N G8895001003Oral aspirin or other antithrombotic therapy prescribed Antrom prescribe 00 9 C M5B 1 0201201012015010120141231N G8896001003Documentation of medical reason(s) for not prescribing oral aspirin or other Doc med reas no antihtrom 00 9 C M5B 1 0201201012015010120141231N G8896002004antithrombotic therapy (e.g., patient documented to be low risk or patient with G8896003004terminal illness or treatment of hypertension with standard treatment goals is G8896004004not clinically appropriate, or for whom risk of aspirin or other antithrombotic G8896005004therapy exceeds potential benefits such as for individuals whose blood pressure G8896006004is poorly controlled) G8897001003Oral aspirin or other antithrombotic therapy was not prescribed, reason not Antithrom not prescribe 00 9 C M5B 1 0201201012015010120141231N G8897002004given G8898001003I intend to report the chronic obstructive pulmonary disease (copd) measures Copd measures group 00 9 C M5B 1 0201201012017010120161231N G8898002004group G8899001003I intend to report the inflammatory bowel disease (ibd) measures group Inflammatory bowel dis mg 00 9 C M5B 1 0201201012017010120161231N G8900001003I intend to report the sleep apnea measures group Obstructive sleep apnea mg 00 9 C M5B 1 0201201012017010120161231N G8902001003I intend to report the dementia measures group Dementia measures group 00 9 C M5B 1 0201201012017010120161231N G8903001003I intend to report the parkinson's disease measures group Parkinson's disease mg 00 9 C M5B 1 0201201012017010120161231N G8904001003I intend to report the hypertension (htn) measures group Hypertension mg 00 9 C M5B 1 0201201012015010120141231N G8905001003I intend to report the cardiovascular prevention measures group Cardiovascular prevention mg00 9 C M5B 1 0201201012015010120141231N G8906001003I intend to report the cataract measures group Cataract measures group 00 9 C M5B 1 0201201012017010120161231N G8907001003Patient documented not to have experienced any of the following events: a burn Pt doc no events on discharg00 9 C M5B 1 02012040120120401 N 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 N 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 N G8910001003Patient documented to have experienced a fall within asc Pt doc to have fall in asc 00 9 C M5B 1 02012040120120401 N G8911001003Patient documented not to have experienced a fall within ambulatory surgical Pt doc no fall in asc 00 9 C M5B 1 02012040120120401 N G8911002004center G8912001003Patient documented to have experienced a wrong site, wrong side, wrong patient, Pt doc with wrong event 00 9 C M5B 1 02012040120120401 N 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 N 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 N 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 N 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 N 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 N 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 N G8918002004(ssi) prophylaxis G8923001003Left ventricular ejection fraction (lvef) < 40% or documentation of moderately Lvef < 40% or lvsd 00 9 C M5B 1 02013010120130101 N G8923002004or severely depressed left ventricular systolic function G8924001003Spirometry test results demonstrate fev1/fvc < 70%, fev < 60% predicted and Spir fev1/fvc<70%,fev<60% 00 9 C M5B 1 02013010120170101 N G8924002004patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) G8925001003Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or Spir fev1/fvc>=60% & no copd00 9 C M5B 1 02013010120170101 N G8925002004patient does not have copd symptoms G8926001003Spirometry test not performed or documented, reason not given Spiro no perf or doc 00 9 C M5B 1 02013010120130101 N G8927001003Adjuvant chemotherapy referred, prescribed or previously received for ajcc Adj chem pres ajcc iii 00 9 C M5B 1 0201301012017010120161231N G8927002004stage iii, colon cancer G8928001003Adjuvant chemotherapy not prescribed or previously received, for documented Adj chem not pres rsn spec 00 9 C M5B 1 0201301012017010120161231N G8928002004reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior G8928003004to the current visit date, patient's diagnosis date is within 120 days of the G8928004004end of the 12 month reporting period, patient's cancer has metastasized, G8928005004medical contraindication/allergy, poor performance status, other medical G8928006004reasons, patient refusal, other patient reasons, patient is currently enrolled G8928007004in a clinical trial that precludes prescription of chemotherapy, other system G8928008004reasons) G8929001003Adjuvant chemotherapy not prescribed or previously received, reason not given Adj cmo not pres rsn not gvn00 9 C M5B 1 0201301012017010120161231N G8930001003Assessment of depression severity at the initial evaluation Assess of dep @ initial eval00 9 C M5B 1 0201301012015010120141231N G8931001003Assessment of depression severity not documented, reason not given Asses of dep not documented 00 9 C M5B 1 0201301012015010120141231N G8932001003Suicide risk assessed at the initial evaluation Suicd rsk assessed init eval00 9 C M5B 1 0201301012015010120141231N G8933001003Suicide risk not assessed at the initial evaluation, reason not given Suicide risk not assessed 00 9 C M5B 1 0201301012015010120141231N G8934001003Left ventricular ejection fraction (lvef) <40% or documentation of moderately Lvef <40% or dep lv sys fcn 00 9 C M5B 1 02013010120130101 N 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 N 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 02013010120150101 N G8936002004converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy G8936003004(eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, G8936004004diseases of the aortic or mitral valve, other medical reasons) or (eg, patient G8936005004declined, other patient reasons) or (eg, lack of drug availability, other G8936006004reasons attributable to the health care system) G8937001003Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or No rx ace/arb therapy 00 9 C M5B 1 02013010120130101 N G8937002004angiotensin receptor blocker (arb) therapy, reason not given G8938001003Bmi is documented as being outside of normal limits, follow-up plan is not Bmi doc onl fup nt doc 00 9 C M5B 1 02013010120180101 N G8938002004documented, documentation the patient is not eligible G8939001003Pain assessment documented as positive, follow-up plan not documented, Pain as doc positive, no f/u00 9 C M5B 1 02013010120180101 N G8939002004documentation the patient is not eligible at the time of the encounter G8940001003Screening for depression documented as positive, a follow-up plan not Scr dep pos, no plan done 00 9 C M5B 1 0201301012017010120161231N G8940002004completed, documented reason G8941001003Elder maltreatment screen documented as positive, follow-up plan not Eld maltreatment doc as pos 00 9 C M5B 1 02013010120180101 N G8941002004documented, documentation the patient is not eligible for follow-up plan at the G8941003004time of the encounter G8942001003Functional outcomes assessment using a standardized tool is documented within Doc fcn/care plan w/30 days 00 9 C M5B 1 02013010120140101 N G8942002004the previous 30 days and care plan, based on identified deficiencies on the G8942003004date of the functional outcome assessment, is documented G8943001003Ldl-c result not present or not within 12 months prior Ldlc not pres w/i 12 mo prir00 9 C M5B 1 0201301012015010120141231N G8944001003Ajcc melanoma cancer stage 0 through iic melanoma Ajcc mel cnr stg 0 - iic 00 9 C M5B 1 02013010120130101 N G8946001003Minimally invasive biopsy method attempted but not diagnostic of breast cancer Mibm but no dx of breast ca 00 9 C M5B 1 02013010120140101 N G8946002004(e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular G8946003004neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical G8946004004columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing G8946005004lesion, papillary lesion, or any lesion with spindle cells) G8947001003One or more neuropsychiatric symptoms 1 or more neuropsych 00 9 C M5B 1 0201301012018010120171231N G8948001003No neuropsychiatric symptoms No neuropsych symptoms 00 9 C M5B 1 0201301012017010120161231N G8949001003Documentation of patient reason(s) for patient not receiving counseling for Doc pt reas on counsel diet 00 9 C M5B 1 0201301012015010120141231N 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, and the Pre-htn or htn doc, f/u indc00 9 C M5B 1 02013010120140101 N G8950002004indicated follow-up is documented G8951001003Pre-hypertensive or hypertensive blood pressure reading documented, indicated Pre-htn/htn doc, no pt f/u 00 9 C M5B 1 0201301012016010120151231N G8951002004follow-up not documented, documentation the patient is not eligible G8952001003Pre-hypertensive or hypertensive blood pressure reading documented, indicated Pre-htn/htn, no f/u, not gvn00 9 C M5B 1 02013010120130101 N 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 0201301012017010120161231N G8953002004have been performed for this patient G8955001003Most recent assessment of adequacy of volume management documented Most recent assess vol mgmt 00 9 C M5B 1 02013010120160101 N G8956001003Patient receiving maintenance hemodialysis in an outpatient dialysis facility Pt rcv hedia outpt dyls fac 00 9 C M5B 1 02013010120130101 N G8957001003Patient not receiving maintenance hemodialysis in an outpatient dialysis Pt no hedia in outpt fac 00 9 C M5B 1 0201301012015010120141231N G8957002004facility G8958001003Assessment of adequacy of volume management not documented, reason not given Assess vol mgmt not doc 00 9 C M5B 1 02013010120130101 N G8959001003Clinician treating major depressive disorder communicates to clinician treating Clin tx mdd comm to tx clin 00 9 C M5B 1 02013010120130101 N G8959002004comorbid condition G8960001003Clinician treating major depressive disorder did not communicate to clinician Clin tx mdd not comm 00 9 C M5B 1 02013010120130101 N 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 N 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 N 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 N 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 N 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 N 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 N G8966002004risk patient or for any reason other than initial detection and risk assessment G8967001003Warfarin or another fda approved oral anticoagulant is prescribed Warf or other fda drug presc00 9 C M5B 1 02013010120180101 N G8968001003Documentation of medical reason(s) for not prescribing warfarin or another Doc med not presb 00 9 C M5B 1 02013010120180101 N G8968002004fda-approved anticoagulant (e.g., atrial appendage device in place) G8969001003Documentation of patient reason(s) for not prescribing warfarin or another Doc pt rsn no presc warf/fda00 9 C M5B 1 02013010120180101 N G8969002004fda-approved oral anticoagulant that is fda approved for the prevention of G8969003004thromboembolism (e.g., patient choice of having atrial appendage device placed) G8970001003No risk factors or one moderate risk factor for thromboembolism No rsk fac or 1 mod risk te 00 9 C M5B 1 02013010120130101 N G8971001003Warfarin or another oral anticoagulant that is fda approved not prescribed, Warfrn or othr antcog no rx 00 9 C M5B 1 0201301012018010120171231N 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 0201301012018010120171231N G8972002004risk factor for thromboembolism G8973001003Most recent hemoglobin (hgb) level < 10 g/dl Mst rcnt hbb < 10g/dl 00 9 C M5B 1 02013010120130101 N G8974001003Hemoglobin level measurement not documented, reason not given Hgb not doc rns not gvn 00 9 C M5B 1 02013010120130101 N G8975001003Documentation of medical reason(s) for patient having a hemoglobin level < 10 Hgb <10g/dl, med rsn 00 9 C M5B 1 02013010120130101 N G8975002004g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell G8975003004anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, G8975004004anemia related to chemotherapy for diagnosis of malignancy, postoperative G8975005004bleeding, active bloodstream or peritoneal infection], other medical reasons) G8976001003Most recent hemoglobin (hgb) level >= 10 g/dl Hgb >= 10 g/dl 00 9 C M5B 1 02013010120130101 N G8977001003I intend to report the oncology measures group Oncology measures grp 00 9 C M5B 1 0201301012017010120161231N G8978001003Mobility: walking & moving around functional limitation, current status, at Mobility current status 00 9 C M5D 1 02013010120130101 N 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 N 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 N 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 N 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 N 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 N 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 N G8984002004therapy episode outset and at reporting intervals G8985001003Carrying, moving and handling objects, projected goal status, at therapy Carry goal status 00 9 C M5D 1 02013010120140101 N G8985002004episode outset, at reporting intervals, and at discharge or to end reporting G8986001003Carrying, moving & handling objects functional limitation, discharge status, at Carry d/c status 00 9 C M5D 1 02013010120130101 N 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 N G8987002004at reporting intervals G8988001003Self care functional limitation, projected goal status, at therapy episode Self care goal status 00 9 C M5D 1 02013010120130101 N 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 N G8989002004to end reporting G8990001003Other physical or occupational therapy primary functional limitation, current Other pt/ot current status 00 9 C M5D 1 02013010120140101 N G8990002004status, at therapy episode outset and at reporting intervals G8991001003Other physical or occupational therapy primary functional limitation, projected Other pt/ot goal status 00 9 C M5D 1 02013010120140101 N G8991002004goal status, at therapy episode outset, at reporting intervals, and at G8991003004discharge or to end reporting G8992001003Other physical or occupational therapy primary functional limitation, discharge Other pt/ot d/c status 00 9 C M5D 1 02013010120140101 N G8992002004status, at discharge from therapy or to end reporting G8993001003Other physical or occupational therapy subsequent functional limitation, Sub pt/ot current status 00 9 C M5D 1 02013010120140101 N G8993002004current status, at therapy episode outset and at reporting intervals G8994001003Other physical or occupational therapy subsequent functional limitation, Sub pt/ot goal status 00 9 C M5D 1 02013010120140101 N G8994002004projected goal status, at therapy episode outset, at reporting intervals, and G8994003004at discharge or to end reporting G8995001003Other physical or occupational therapy subsequent functional limitation, Sub pt/ot d/c status 00 9 C M5D 1 02013010120140101 N G8995002004discharge status, at discharge from therapy or to end reporting G8996001003Swallowing functional limitation, current status at therapy episode outset and Swallow current status 00 9 C M5D 1 02013010120140101 N G8996002004at reporting intervals G8997001003Swallowing functional limitation, projected goal status, at therapy episode Swallow goal status 00 9 C M5D 1 02013010120140101 N G8997002004outset, at reporting intervals, and at discharge or to end reporting G8998001003Swallowing functional limitation, discharge status, at discharge from therapy Swallow d/c status 00 9 C M5D 1 02013010120140101 N G8998002004or to end reporting G8999001003Motor speech functional limitation, current status at therapy episode outset Motor speech current status 00 9 C M5D 1 02013010120140101 N G8999002004and at 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) 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 G9143001003Warfarin responsiveness testing by genetic technique using any method, any Warfarin respon genetic test1321 A 220400 C M5D 1 02009080320140101 N 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 1 medical home Medical home level 1 00 9 C Z2 1 02011070120110701 N G9149001003National committee for quality assurance - level 2 medical home Medical home level ii 00 9 C Z2 1 02011070120110701 N G9150001003National committee for quality assurance - level 3 medical home Medical home level iii 00 9 C Z2 1 02011070120110701 N G9151001003Mapcp demonstration - state provided services Mapcp demo state 00 9 C Z2 1 02011070120110701 N G9152001003Mapcp demonstration - community health teams Mapcp demo community 00 9 C Z2 1 02011070120110701 N G9153001003Mapcp demonstration - physician incentive pool Mapcp demo physician 00 9 C Z2 1 02011070120110701 N G9156001003Evaluation for wheelchair requiring face to face visit with physician Evaluation for wheelchair 00 9 C Z2 1 02012010120120101 N G9157001003Transesophageal doppler measurement of cardiac output (including probe Transesoph doppl cardiac mon00 9 C T2C 1 02013010120130101 N G9157002004placement, image acquisition, and interpretation per course of treatment) for G9157003004monitoring purposes G9158001003Motor speech functional limitation, discharge status, at discharge from therapy Motor speech d/c status 00 9 C M5D 1 02013010120140101 N G9158002004or to end reporting G9159001003Spoken language comprehension functional limitation, current status at therapy Lang comp current status 00 9 C M5D 1 02013010120140101 N G9159002004episode outset and at reporting intervals G9160001003Spoken language comprehension functional limitation, projected goal status at Lang comp goal status 00 9 C M5D 1 02013010120150101 N G9160002004therapy episode outset, at reporting intervals, and at discharge or to end G9160003004reporting G9161001003Spoken language comprehension functional limitation, discharge status, at Lang comp d/c status 00 9 C M5D 1 02013010120140101 N G9161002004discharge from therapy or to end reporting G9162001003Spoken language expression functional limitation, current status at therapy Lang express current status 00 9 C M5D 1 02013010120140101 N G9162002004episode outset and at reporting intervals G9163001003Spoken language expression functional limitation, projected goal status at Lang express goal status 00 9 C M5D 1 02013010120150101 N G9163002004therapy episode outset, at reporting intervals, and at discharge or to end G9163003004reporting G9164001003Spoken language expression functional limitation, discharge status at discharge Lang express d/c status 00 9 C M5D 1 02013010120140101 N G9164002004from therapy or to end reporting G9165001003Attention functional limitation, current status at therapy episode outset and Atten current status 00 9 C M5D 1 02013010120140101 N G9165002004at reporting intervals G9166001003Attention functional limitation, projected goal status at therapy episode Atten goal status 00 9 C M5D 1 02013010120150101 N G9166002004outset, at reporting intervals, and at discharge or to end reporting G9167001003Attention functional limitation, discharge status at discharge from therapy or Atten d/c status 00 9 C M5D 1 02013010120140101 N G9167002004to end reporting G9168001003Memory functional limitation, current status at therapy episode outset and at Memory current status 00 9 C M5D 1 02013010120140101 N G9168002004reporting intervals G9169001003Memory functional limitation, projected goal status at therapy episode outset, Memory goal status 00 9 C M5D 1 02013010120150101 N G9169002004at reporting intervals, and at discharge or to end reporting G9170001003Memory functional limitation, discharge status at discharge from therapy or to Memory d/c status 00 9 C M5D 1 02013010120140101 N G9170002004end reporting G9171001003Voice functional limitation, current status at therapy episode outset and at Voice current status 00 9 C M5D 1 02013010120140101 N G9171002004reporting intervals G9172001003Voice functional limitation, projected goal status at therapy episode outset, Voice goal status 00 9 C M5D 1 02013010120150101 N G9172002004at reporting intervals, and at discharge or to end reporting G9173001003Voice functional limitation, discharge status at discharge from therapy or to Voice d/c status 00 9 C M5D 1 02013010120140101 N G9173002004end reporting G9174001003Other speech language pathology functional limitation, current status at Speech lang current status 00 9 C M5D 1 02013010120140101 N G9174002004therapy episode outset and at reporting intervals G9175001003Other speech language pathology functional limitation, projected goal status at Speech lang goal status 00 9 C M5D 1 02013010120150101 N G9175002004therapy episode outset, at reporting intervals, and at discharge or to end G9175003004reporting G9176001003Other speech language pathology functional limitation, discharge status at Speech lang d/c status 00 9 C M5D 1 02013010120140101 N G9176002004discharge from therapy or to end reporting G9186001003Motor speech functional limitation, projected goal status at therapy episode Motor speech goal status 00 9 C M5D 1 02013010120150101 N G9186002004outset, at reporting intervals, and at discharge or to end reporting G9187001003Bundled payments for care improvement initiative home visit for patient Bpci home visit 13 A C M5D 1 02013100120131001 N G9187002004assessment performed by a qualified health care professional for individuals G9187003004not considered homebound including, but not limited to, assessment of safety, G9187004004falls, clinical status, fluid status, medication reconciliation/management, G9187005004patient compliance with orders/plan of care, performance of activities of daily G9187006004living, appropriateness of care setting; (for use only in the meidcare-approved G9187007004bundled payments for care improvement initiative); may not be billed for a G918700800430-day period covered by a transitional care management code G9188001003Beta-blocker therapy not prescribed, reason not given Beta not given no reason 00 9 C M5B 1 02014010120140101 N G9189001003Beta-blocker therapy prescribed or currently being taken Beta pres or already taking 00 9 C M5B 1 02014010120140101 N G9190001003Documentation of medical reason(s) for not prescribing beta-blocker therapy Medical reason for no beta 00 9 C M5B 1 02014010120140101 N G9190002004(eg, allergy, intolerance, other medical reasons) G9191001003Documentation of patient reason(s) for not prescribing beta-blocker therapy Pt reason for no beta 00 9 C M5B 1 02014010120140101 N G9191002004(eg, patient declined, other patient reasons) G9192001003Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, System reason for no beta 00 9 C M5B 1 02014010120140101 N G9192002004other reasons attributable to the health care system) G9193001003Clinician documented that patient with a diagnosis of major depression was not Doc not eligible for dep med00 9 C M5B 1 0201401012015010120141231N G9193002004an eligible candidate for antidepressant medication treatment or patient did G9193003004not have a diagnosis of major depression G9194001003Patient with a diagnosis of major depression documented as being treated with Mdd pt treated for 180d 00 9 C M5B 1 0201401012015010120141231N G9194002004antidepressant medication during the entire 180 day (6 month) continuation G9194003004treatment phase G9195001003Patient with a diagnosis of major depression not documented as being treated Mdd pt not treated for 180d 00 9 C M5B 1 0201401012015010120141231N G9195002004with antidepressant medication during the entire 180 day (6 months) G9195003004continuation treatment phase G9196001003Documentation of medical reason(s) for not ordering a first or second Med reason for no ceph 00 9 C M5B 1 02014010120160101 N G9196002004generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled G9196003004in clinical trials, patients with documented infection prior to surgical G9196004004procedure of interest, patients who were receiving antibiotics more than 24 G9196005004hours prior to surgery [except colon surgery patients taking oral prophylactic G9196006004antibiotics], patients who were receiving antibiotics within 24 hours prior to G9196007004arrival [except colon surgery patients taking oral prophylactic antibiotics], G9196008004other medical reason(s)) G9197001003Documentation of order for first or second generation cephalosporin for Order for ceph 00 9 C M5B 1 02014010120140101 N G9197002004antimicrobial prophylaxis G9198001003Order for first or second generation cephalosporin for antimicrobial No order for ceph no reason 00 9 C M5B 1 02014010120140101 N G9198002004prophylaxis was not documented, reason not given G9199001003Venous thromboembolism (vte) prophylaxis not administered the day of or the day Doc reason for no vte 00 9 C M5B 1 0201401012015010120141231N G9199002004after hospital admission for documented reasons (eg, patient is ambulatory, G9199003004patient expired during inpatient stay, patient already on warfarin or another G9199004004anticoagulant, other medical reason(s) or eg, patient left against medical G9199005004advice, other patient reason(s)) G9200001003Venous thromboembolism (vte) prophylaxis was not administered the day of or the No reason for no vte 00 9 C M5B 1 0201401012015010120141231N G9200002004day after hospital admission, reason not given G9201001003Venous thromboembolism (vte) prophylaxis administered the day of or the day Vte given upon admission 00 9 C M5B 1 0201401012015010120141231N G9201002004after hospital admission G9202001003Patients with a positive hepatitis c antibody test Hep c aby pos 00 9 C M5B 1 0201401012015010120141231N G9203001003Rna testing for hepatitis c documented as performed within 12 months prior to Hep c rna done prior to med 00 9 C M5B 1 0201401012017010120161231N G9203002004initiation of antiviral treatment for hepatitis c G9204001003Rna testing for hepatitis c was not documented as performed within 12 months No reason for no hep c rna 00 9 C M5B 1 0201401012017010120161231N G9204002004prior to initiation of antiviral treatment for hepatitis c, reason not given G9205001003Patient starting antiviral treatmentfor hepatitis c during the measurement Hep c antiviral started 00 9 C M5B 1 0201401012017010120161231N G9205002004period G9206001003Patient starting antiviral treatment for hepatitis c during the measurement Hep c therapy started 00 9 C M5B 1 0201401012017010120161231N G9206002004period G9207001003Hepatitis c genotype testing documented as performed within 12 months prior to Hep c genotype prior to med 00 9 C M5B 1 0201401012017010120161231N G9207002004initiation of antiviral treatment for hepatitis c G9208001003Hepatitis c genotype testing was not documented as performed within 12 months No reason for no hep c geno 00 9 C M5B 1 0201401012017010120161231N G9208002004prior to initiation of antiviral treatment for hepatitis c, reason not given G9209001003Hepatitis c quantitative rna testing documented as performed between 4-12 weeks Hep c rna 4to12 wk after med00 9 C M5B 1 0201401012017010120161231N G9209002004after the initiation of antiviral treatment G9210001003Hepatitis c quantitative rna testing not performed between 4-12 weeks after the No hepc rna after med docrsn00 9 C M5B 1 0201401012017010120161231N G9210002004initiation of antiviral treatment for documented reason(s) (e.g., patients G9210003004whose treatment was discontinued during the testing period prior to testing, G9210004004other medical reasons, patient declined, other patient reasons) G9211001003Hepatitis c quantitative rna testing was not documented as performed between No hepc rna after med no rsn00 9 C M5B 1 0201401012017010120161231N G92110020044-12 weeks after the initiation of antiviral treatment, reason not given G9212001003Dsm-ivtm criteria for major depressive disorder documented at the initial Doc of dsm-iv init eval 00 9 C M5B 1 02014010120140101 N G9212002004evaluation G9213001003Dsm-iv-tr criteria for major depressive disorder not documented at the initial No doc of dsm-iv 00 9 C M5B 1 02014010120140101 N G9213002004evaluation, reason not otherwise specified G9214001003Cd4+ cell count or cd4+ cell percentage results documented Cd4 count documented 00 9 C M5B 1 0201401012015010120141231N G9215001003Cd4+ cell count or percentage not documented as performed, reason not given No cd4 count no reason 00 9 C M5B 1 0201401012015010120141231N G9216001003Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not givenNo pcp proph at dx no reason00 9 C M5B 1 0201401012015010120141231N G9217001003Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below No pcp proph low cd4 norsn 00 9 C M5B 1 0201401012017010120161231N G9217002004200 cells/mm3, reason not given G9218001003Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below No pcp prop low at cd4 norsn00 9 C M5B 1 0201401012015010120141231N G9218002004500 cells/mm3 or a cd4 percentage below 15%, reason not given G9219001003Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of No oder pjp for med reason 00 9 C M5B 1 0201401012017010120161231N G9219002004low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's G9219003004cd4+ cell count above threshold within 3 months after cd4+ cell count below G9219004004threshold, indicating that the patient's cd4+ levels are within an acceptable G9219005004range and the patient does not require pcp prophylaxis) G9220001003Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of No order for pjp for medrsn 00 9 C M5B 1 0201401012015010120141231N G9220002004low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for G9220003004medical reason (i.e., patient's cd4+ cell count above threshold within 3 months G9220004004after cd4+ cell count below threshold, indicating that the patient's cd4+ G9220005004levels are within an acceptable range and the patient does not require pcp G9220006004prophylaxis) G9221001003Pneumocystis jiroveci pneumonia prophlaxis prescribed Pjp proph prescribed 00 9 C M5B 1 0201401012015010120141231N G9222001003Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low Pjp proph ordered low cd4 00 9 C M5B 1 0201401012017010120161231N G9222002004cd4+ cell count below 200 cells/mm3 G9223001003Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low Pjp proph ordered cd4 low 00 9 C M5B 1 02014010120140101 N G9223002004cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% G9224001003Documentation of medical reason for not performing foot exam (e.g., patient Medrsn no foot exam 00 9 C M5B 1 0201401012015010120141231N G9224002004with bilateral foot/leg amputation) G9225001003Foot exam was not performed, reason not given Norsn no foot exam 00 9 C M5B 1 02014010120140101 N G9226001003Foot examination performed (includes examination through visual inspection, 3 comp foot exam completed 00 9 C M5B 1 02014010120160101 N G9226002004sensory exam with 10-g monofilament plus testing any one of the following: G9226003004vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or G9226004004vibration perception threshold, and pulse exam; report when all of the 3 G9226005004components are completed) G9227001003Functional outcome assessment documented, care plan not documented, Foa doc, care plan not doc 00 9 C M5B 1 02014010120180101 N G9227002004documentation the patient is not eligible for a care plan at the time of the G9227003004encounter G9228001003Chlamydia, gonorrhea and syphilis screening results documented (report when Gc chl syp documented 00 9 C M5B 1 02014010120140101 N G9228002004results are present for all of the 3 screenings) G9229001003Chlamydia, gonorrhea, and syphilis screening results not documented (patient Ptrsn no gc chl syp test 00 9 C M5B 1 02014010120170101 N G9229002004refusal is the only allowed exception) G9230001003Chlamydia, gonorrhea, and syphilis not screened, reason not given Norsn for gc chl syp test 00 9 C M5B 1 02014010120140101 N G9231001003Documentation of end stage renal disease (esrd), dialysis, renal transplant Doc esrd dia trans preg 00 9 C M5B 1 02014010120170101 N G9231002004before or during the measurement period or pregnancy during the measurement G9231003004period G9232001003Clinician treating major depressive disorder did not communicate to clinician Ptrsn no comm comorbid 00 9 C M5B 1 02014010120170101 N G9232002004treating comorbid condition for specified patient reason (e.g., patient is G9232003004unable to communicate the diagnosis of a comorbid condition; the patient is G9232004004unwilling to communicate the diagnosis of a comorbid condition; or the patient G9232005004is unaware of the comorbid condition, or any other specified patient reason) G9233001003All quality actions for the applicable measures in the total knee replacement Tkr composite 00 9 C M5B 1 0201401012017010120161231N G9233002004measures group have been performed for this patient G9234001003I intend to report the total knee replacement measures group Tkr intent 00 9 C M5B 1 0201401012017010120161231N G9235001003All quality actions for the applicable measures in the general surgery measures Gs mg composite 00 9 C M5B 1 0201401012017010120161231N G9235002004group have been performed for this patient G9236001003All quality actions for the applicable measures in the optimizing patient Op rad mg composite 00 9 C M5B 1 0201401012017010120161231N G9236002004exposure to ionizing radiation measures group have been performed for this G9236003004patient G9237001003I intend to report the general surgery measures group Gs mg intent 00 9 C M5B 1 0201401012017010120161231N G9238001003I intend to report the optimizing patient exposure to ionizing radiation Op rad mg intent 00 9 C M5B 1 0201401012017010120161231N G9238002004measures group G9239001003Documentation of reasons for patient initiaiting maintenance hemodialysis with Doc rsn hemod & cath acc 00 9 C M5B 1 02014010120170101 N G9239002004a catheter as the mode of vascular access (e.g., patient has a maturing G9239003004avf/avg, time-limited trial of hemodialysis, other medical reasons, patient G9239004004declined avf/avg, other patient reasons, patient followed by reporting G9239005004nephrologist for fewer than 90 days, other system reasons) G9240001003Patient whose mode of vascular access is a catheter at the time maintenance Doc pt w cath maint dia 00 9 C M5B 1 02014010120140101 N G9240002004hemodialysis is initiated G9241001003Patient whose mode of vascular access is not a catheter at the time maintenance Doc pt w out cath maint dia 00 9 C M5B 1 02014010120140101 N G9241002004hemodialysis is initiated G9242001003Documentation of viral load equal to or greater than 200 copies/ml or viral Doc viral load >=200 00 9 C M5B 1 02014010120150101 N G9242002004load not performed G9243001003Documentation of viral load less than 200 copies/ml Doc viral load <200 00 9 C M5B 1 02014010120140101 N G9244001003Antiretroviral thereapy not prescribed Antiviral not ordered 00 9 C M5B 1 0201401012017010120161231N G9245001003Antiretroviral therapy prescribed Antiviral ordered 00 9 C M5B 1 0201401012017010120161231N G9246001003Patient did not have at least one medical visit in each 6 month period of the No med visit in 24mo 00 9 C M5B 1 02014010120140101 N G924600200424 month measurement period, with a minimum of 60 days between medical visits G9247001003Patient had at least one medical visit in each 6 month period of the 24 month 1 med visit in 24mo 00 9 C M5B 1 02014010120140101 N G9247002004measurement period, with a minimum of 60 days between medical visits G9248001003Patient did not have a medical visit in the last 6 months No med visit 6mo 00 9 C M5B 1 0201401012015010120141231N G9249001003Patient had a medical visit in the last 6 months Med visit w in 6mo 00 9 C M5B 1 0201401012015010120141231N G9250001003Documentation of patient pain brought to a comfortable level within 48 hours Doc of pain comfort 48hr 00 9 C M5B 1 02014010120140101 N G9250002004from initial assessment G9251001003Documentation of patient with pain not brought to a comfortable level within 48 Doc no pain comfort 48hr 00 9 C M5B 1 02014010120140101 N G9251002004hours from initial assessment G9252001003Adenoma(s) or other neoplasm detected during screening colonoscopy Neo detect scrn colo 00 9 C M5B 1 0201401012015010120141231N G9253001003Adenoma(s) or other neoplasm not detected during screening colonoscopy No neo detect scrn colo 00 9 C M5B 1 0201401012015010120141231N G9254001003Documentation of patient discharged to home later than post-operative day 2 Doc pt dischg >2d 00 9 C M5B 1 02014010120140101 N G9254002004following cas G9255001003Documentation of patient discharged to home no later than post operative day 2 Doc pt dischg <=2d 00 9 C M5B 1 02014010120140101 N G9255002004following cas G9256001003Documentation of patient death following cas Doc of pat death after cas 00 9 C M5B 1 02014010120180101 N G9257001003Documentation of patient stroke following cas Doc of pat stroke after cas 00 9 C M5B 1 02014010120180101 N G9258001003Documentation of patient stroke following cea Doc of pat stroke after cea 00 9 C M5B 1 02014010120180101 N G9259001003Documentation of patient survival and absence of stroke following cas Survive/no stroke post cas 00 9 C M5B 1 02014010120180101 N G9260001003Documentation of patient death following cea Doc of pat death after cea 00 9 C M5B 1 02014010120180101 N G9261001003Documentation of patient survival and absence of stroke following cea Survive/no stroke post cea 00 9 C M5B 1 02014010120180101 N G9262001003Documentation of patient death in the hospital following endovascular aaa repairDoc of death post-aaa repair00 9 C M5B 1 02014010120180101 N G9263001003Documentation of patient discharged alive following endovascular aaa repair Doc of disch post-aaa repair00 9 C M5B 1 02014010120180101 N G9264001003Documentation of patient receiving maintenance hemodialysis for greater than or Doc rsn hemod w/cath >=90d 00 9 C M5B 1 02014010120170101 N G9264002004equal to 90 days with a catheter for documented reasons (e.g., other medical G9264003004reasons, patient declined avf/avg, other patient reasons) G9265001003Patient receiving maintenance hemodialysis for greater than or equal to 90 days Doc cath >90d for maint dia 00 9 C M5B 1 02014010120140101 N G9265002004with a catheter as the mode of vascular access G9266001003Patient receiving maintenance hemodialysis for greater than or equal to 90 days Norsn pt cath >=90d 00 9 C M5B 1 02014010120140101 N G9266002004without a catheter as the mode of vascular access G9267001003Documentation of patient with one or more complications or mortality within 30 Doc comp or mort w in 30d 00 9 C M5B 1 02014010120140101 N G9267002004days G9268001003Documentation of patient with one or more complications within 90 days Doc comp or mort w in 90d 00 9 C M5B 1 02014010120140101 N G9269001003Documentation of patient without one or more complications and without Doc no comp or mort w in 30d00 9 C M5B 1 02014010120140101 N G9269002004mortality within 30 days G9270001003Documentation of patient without one or more complications within 90 days Doc no comp or mort w in 90d00 9 C M5B 1 02014010120140101 N G9271001003Ldl value < 100 Ldl under 100 00 9 C M5B 1 0201401012015010120141231N G9272001003Ldl value >= 100 Ldl 100 and over 00 9 C M5B 1 0201401012015010120141231N G9273001003Blood pressure has a systolic value of < 140 and a diastolic value of < 90 Sys<140 and dia<90 00 9 C M5B 1 02014010120140101 N G9274001003Blood pressure has a systolic value of =140 and a diastolic value of = 90 or Bp out of nrml limits 00 9 C M5B 1 02014010120140101 N G9274002004systolic value < 140 and diastolic value = 90 or systolic value = 140 and G9274003004diastolic value < 90 G9275001003Documentation that patient is a current non-tobacco user Doc of non tobacco user 00 9 C M5B 1 02014010120140101 N G9276001003Documentation that patient is a current tobacco user Doc of tobacco user 00 9 C M5B 1 02014010120140101 N G9277001003Documentation that the patient is on daily aspirin or anti-platelet or has Doc daily aspirin or contra 00 9 C M5B 1 02014010120160101 N G9277002004documentation of a valid contraindication or exception to G9277003004aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, G9277004004allergy to aspirin or anti-platelets, history of gastrointestinal bleed and G9277005004bleeding disorder; additionally, the following exceptions documented by the G9277006004physician as a reason for not taking daily aspirin or anti-platelet are G9277007004acceptable (use of non-steroidal anti-inflammatory agents, documented risk for G9277008004drug interaction, uncontrolled hypertension defined as >180 systolic or >110 G9277009004diastolic or gastroesophageal reflux) G9278001003Documentation that the patient is not on daily aspirin or anti-platelet regimen Doc no daily aspirin 00 9 C M5B 1 02014010120150101 N G9279001003Pneumococcal screening performed and documentation of vaccination received Pne scrn done doc vac done 00 9 C M5B 1 02014010120140101 N G9279002004prior to discharge G9280001003Pneumococcal vaccination not administered prior to discharge, reason not Pne not given norsn 00 9 C M5B 1 02014010120140101 N G9280002004specified G9281001003Screening performed and documentation that vaccination not indicated/patient Pne scrn done doc not ind 00 9 C M5B 1 02014010120140101 N G9281002004refusal G9282001003Documentation of medical reason(s) for not reporting the histological type or Doc medrsn no histo type 00 9 C M5B 1 02014010120140101 N G9282002004nsclc-nos classification with an explanation (e.g., biopsy taken for other G9282003004purposes in a patient with a history of non-small cell lung cancer or other G9282004004documented medical reasons) G9283001003Non small cell lung cancer biopsy and cytology specimen report documents Hist type doc on report 00 9 C M5B 1 02014010120140101 N G9283002004classification into specific histologic type or classified as nsclc-nos with an G9283003004explanation G9284001003Non small cell lung cancer biopsy and cytology specimen report does not No hist type doc on report 00 9 C M5B 1 02014010120140101 N G9284002004document classification into specific histologic type or classified as G9284003004nsclc-nos with an explanation G9285001003Specimen site other than anatomic location of lung or is not classified as non Site not small cell lung ca 00 9 C M5B 1 02014010120140101 N G9285002004small cell lung cancer G9286001003Antibiotic regimen prescribed within 10 days after onset of symptoms Antibio rx w in 10d of sympt00 9 C M5B 1 02014010120160101 N G9287001003Antibiotic regimen not prescribed within 10 days after onset of symptoms No antibio w in 10d of sympt00 9 C M5B 1 02014010120160101 N G9288001003Documentation of medical reason(s) for not reporting the histological type or Doc medrsn no hist type rpt 00 9 C M5B 1 02014010120140101 N G9288002004nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in G9288003004a person with a history of non-small cell carcinoma or other documented medical G9288004004reasons) G9289001003Non small cell lung cancer biopsy and cytology specimen report documents Doc type nsm lung ca 00 9 C M5B 1 02014010120140101 N G9289002004classification into specific histologic type or classified as nsclc-nos with an G9289003004explanation G9290001003Non small cell lung cancer biopsy and cytology specimen report does not No doc type nsm lung ca 00 9 C M5B 1 02014010120140101 N G9290002004document classification into specific histologic type or classified as G9290003004nsclc-nos with an explanation G9291001003Specimen site other than anatomic location of lung, is not classified as non Not nsm lung ca 00 9 C M5B 1 02014010120140101 N G9291002004small cell lung cancer or classified as nsclc-nos G9292001003Documentation of medical reason(s) for not reporting pt category and a Medrsn no pt category 00 9 C M5B 1 02014010120140101 N G9292002004statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative G9292003004skin biopsies in a patient with a history of melanoma or other documented G9292004004medical reasons) G9293001003Pathology report does not include the pt category and a statement on thickness No pt category on report 00 9 C M5B 1 02014010120140101 N G9293002004and ulceration and for pt1, mitotic rate G9294001003Pathology report includes the pt category and a statement on thickness and Pt cat and thck on report 00 9 C M5B 1 02014010120140101 N G9294002004ulceration and for pt1, mitotic rate G9295001003Specimen site other than anatomic cutaneous location Non cutaneous loc 00 9 C M5B 1 02014010120140101 N G9296001003Patients with documented shared decision-making including discussion of Doc share dec prior proc 00 9 C M5B 1 02014010120150101 N G9296002004conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, G9296003004exercise, injections) prior to the procedure G9297001003Shared decision-making including discussion of conservative (non-surgical) No doc share dec prior proc 00 9 C M5B 1 02014010120150101 N G9297002004therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to G9297003004the procedure, not documented, reason not given G9298001003Patients who are evaluated for venous thromboembolic and cardiovascular risk Eval risk vte card 30d prior00 9 C M5B 1 02014010120150101 N G9298002004factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, G9298003004arrhythmia and stroke) G9299001003Patients who are not evaluated for venous thromboembolic and cardiovascular No eval riskk vte card prior00 9 C M5B 1 02014010120150101 N G9299002004risk factors within 30 days prior to the procedure including (e.g., history of G9299003004dvt, pe, mi, arrhythmia and stroke, reason not given) G9300001003Documentation of medical reason(s) for not completely infusing the prophylactic Doc medrsn no compl antibio 00 9 C M5B 1 02014010120140101 N G9300002004antibiotic prior to the inflation of the proximal tourniquet (e.g., a G9300003004tourniquet was not used) G9301001003Patients who had the prophylactic antibiotic completely infused prior to the Doc compl inf antibio 00 9 C M5B 1 02014010120140101 N G9301002004inflation of the proximal tourniquet G9302001003Prophylactic antibiotic not completely infused prior to the inflation of the Norsn incomp inf antibio 00 9 C M5B 1 02014010120140101 N G9302002004proximal tourniquet, reason not given G9303001003Operative report does not identify the prosthetic implant specifications Norsn no pros info op rpt 00 9 C M5B 1 02014010120150101 N G9303002004including the prosthetic implant manufacturer, the brand name of the prosthetic G9303003004implant and the size of each prosthetic implant, reason not given G9304001003Operative report identifies the prosthetic implant specifications including the Pros info op rpt 00 9 C M5B 1 02014010120150101 N G9304002004prosthetic implant manufacturer, the brand name of the prosthetic implant and G9304003004the size of each prosthetic implant G9305001003Intervention for presence of leak of endoluminal contents through an No interv req for leak 00 9 C M5B 1 02014010120140101 N G9305002004anastomosis not required G9306001003Intervention for presence of leak of endoluminal contents through an Interv req for leak 00 9 C M5B 1 02014010120140101 N G9306002004anastomosis required G9307001003No return to the operating room for a surgical procedure, for complications of No ret for surg w in 30d 00 9 C M5B 1 02014010120170101 N G9307002004the principal operative procedure, within 30 days of the principal operative G9307003004procedure G9308001003Unplanned return to the operating room for a surgical procedure, for Unpl ret or w/compl w/in 30d00 9 C M5B 1 02014010120170101 N G9308002004complications of the principal operative procedure, within 30 days of the G9308003004principal operative procedure G9309001003No unplanned hospital readmission within 30 days of principal procedure No unplnd hosp readm in 30d 00 9 C M5B 1 02014010120140101 N G9310001003Unplanned hospital readmission within 30 days of principal procedure Unplnd hosp readm in 30d 00 9 C M5B 1 02014010120140101 N G9311001003No surgical site infection No surg site infection 00 9 C M5B 1 02014010120140101 N G9312001003Surgical site infection Surgical site infection 00 9 C M5B 1 02014010120140101 N G9313001003Amoxicillin, with or without clavulanate, not prescribed as first line Amoxic not presc as 1st line00 9 C M5B 1 02014010120180101 N G9313002004antibiotic at the time of diagnosis for documented reason G9314001003Amoxicillin, with or without clavulanate, not prescribed as first line Norsn not first line amox 00 9 C M5B 1 02014010120140101 N G9314002004antibiotic at the time of diagnosis, reason not given G9315001003Documentation amoxicillin, with or without clavulanate, prescribed as a first Doc first line amox 00 9 C M5B 1 02014010120140101 N G9315002004line antibiotic at the time of diagnosis G9316001003Documentation of patient-specific risk assessment with a risk calculator based Doc comm risk calc 00 9 C M5B 1 02014010120140101 N G9316002004on multi-institutional clinical data, the specific risk calculator used, and G9316003004communication of risk assessment from risk calculator with the patient or family G9317001003Documentation of patient-specific risk assessment with a risk calculator based No doc comm risk calc 00 9 C M5B 1 02014010120140101 N G9317002004on multi-institutional clinical data, the specific risk calculator used, and G9317003004communication of risk assessment from risk calculator with the patient or G9317004004family not completed G9318001003Imaging study named according to standardized nomenclature Image std nomenclature 00 9 C M5B 1 02014010120140101 N G9319001003Imaging study not named according to standardized nomenclature, reason not givenImage not std nomenclature 00 9 C M5B 1 02014010120140101 N G9320001003Documentation of medical reason(s) for not naming ct studies according to a Medrsn no std nomenclature 00 9 C M5B 1 0201401012016010120151231N G9320002004standardized nomenclature provided (eg, ct studies performed for radiation G9320003004treatment planning or image-guided radiation treatment delivery) G9321001003Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial Doc count of ct in 12mo 00 9 C M5B 1 02014010120140101 N G9321002004perfusion) studies documented in the 12-month period prior to the current study G9322001003Count of previous ct and cardiac nuclear medicine (myocardial perfusion) No doc count of ct in 12mo 00 9 C M5B 1 02014010120140101 N G9322002004studies not documented in the 12-month period prior to the current study, G9322003004reason not given G9323001003Documentation of medical reason(s) for not counting previous ct and cardiac Mdrsn no doc cnt of ct 00 9 C M5B 1 0201401012016010120151231N G9323002004nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for G9323003004radiation treatment planning or image-guided radiation treatment delivery) G9324001003All necessary data elements not included, reason not given Not all data norsn 00 9 C M5B 1 0201401012017010120161231N G9325001003Ct studies not reported to a radiation dose index registry due to medical Medrsn no ct rpt to reg 00 9 C M5B 1 0201401012016010120151231N G9325002004reasons (eg, ct studies performed for radiation treatment planning or G9325003004image-guided radiation treatment delivery) G9326001003Ct studies performed not reported to a radiation dose index registry that is Ct done no rad ds index, nrg00 9 C M5B 1 02014010120170101 N G9326002004capable of collecting at a minimum all necessary data elements, reason not given G9327001003Ct studies performed reported to a radiation dose index registry that is Ct done rad ds index 00 9 C M5B 1 02014010120170101 N G9327002004capable of collecting at a minimum all necessary data elements G9328001003Dicom format image data availability not documented in final report due to Medrsn no dicom format doc 00 9 C M5B 1 0201401012016010120151231N G9328002004medical reasons (eg, ct studies performed for radiation treatment planning or G9328003004image-guided radiation treatment delivery) G9329001003Dicom format image data available to non-affiliated external healthcare Norsn no dicom format doc 00 9 C M5B 1 02014010120150101 N G9329002004facilities or entities on a secure, media free, reciprocally searchable basis G9329003004with patient authorization for at least a 12-month period after the study not G9329004004documented in final report, reason not given G9340001003Final report documented that dicom format image data available to Dicom format doc on rpt 00 9 C M5B 1 02014010120150101 N G9340002004non-affiliated external healthcare facilities or entities on a secure, media G9340003004free, reciprocally searchable basis with patient authorization for at least a G934000400412-month period after the study G9341001003Search conducted for prior patient ct studies completed at non-affiliated Srch for ct w in 12 mos 00 9 C M5B 1 02014010120150101 N G9341002004external healthcare facilities or entities within the past 12-months and are G9341003004available through a secure, authorized, media-free, shared archive prior to an G9341004004imaging study being performed G9342001003Search not conducted prior to an imaging study being performed for prior No srch for ct in 12mo norsn00 9 C M5B 1 02014010120150101 N G9342002004patient ct studies completed at non-affiliated external healthcare facilities G9342003004or entities within the past 12-months and are available through a secure, G9342004004authorized, media-free, shared archive, reason not given G9343001003Due to medical reasons, search not conducted for dicom format images for prior Medrsn no dicom srch 00 9 C M5B 1 0201401012016010120151231N G9343002004patient ct imaging studies completed at non-affiliated external healthcare G9343003004facilities or entities within the past 12 months that are available through a G9343004004secure, authorized, media-free, shared archive (e.g., ct studies performed for G9343005004radiation treatment planning or image-guided radiation treatment delivery) G9344001003Due to system reasons search not conducted for dicom format images for prior Sysrsn no dicom srch 00 9 C M5B 1 02014010120150101 N G9344002004patient ct imaging studies completed at non-affiliated external healthcare G9344003004facilities or entities within the past 12 months that are available through a G9344004004secure, authorized, media-free, shared archive (e.g., non-affiliated external G9344005004healthcare facilities or entities does not have archival abilities through a G9344006004shared archival system) G9345001003Follow-up recommendations documented according to recommended guidelines for Follow up pulm nod 00 9 C M5B 1 02014010120150101 N G9345002004incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies G9345003004needed or that no follow-up is needed) based at a minimum on nodule size and G9345004004patient risk factors G9346001003Follow-up recommendations not documented according to recommended guidelines No follow up pulm nod 00 9 C M5B 1 0201401012016010120151231N G9346002004for incidentally detected pulmonary nodules due to medical reasons (e.g., G9346003004patients with known malignant disease, patients with unexplained fever, ct G9346004004studies performed for radiation treatment planning or image-guided radiation G9346005004treatment delivery) G9347001003Follow-up recommendations not documented according to recommended guidelines No follow up pulm nod norsn 00 9 C M5B 1 02014010120150101 N G9347002004for incidentally detected pulmonary nodules, reason not given G9348001003Ct scan of the paranasal sinuses ordered at the time of diagnosis for Doc rsn for ord ct scan 00 9 C M5B 1 02014010120180101 N G9348002004documented reasons G9349001003Documentation of a ct scan of the paranasal sinuses ordered at the time of Doc sinus ct 28d 00 9 C M5B 1 02014010120140101 N G9349002004diagnosis or received within 28 days after date of diagnosis G9350001003Ct scan of the paranasal sinuses not ordered at the time of diagnosis or No doc sinus ct 28d or dx 00 9 C M5B 1 02014010120140101 N G9350002004received within 28 days after date of diagnosis G9351001003More than one ct scan of the paranasal sinuses ordered or received within 90 Doc >1 sinus ct w 90d dx 00 9 C M5B 1 02014010120140101 N G9351002004days after diagnosis G9352001003More than one ct scan of the paranasal sinuses ordered or received within 90 Not >1 sinus ct w 90d dx 00 9 C M5B 1 02014010120140101 N G9352002004days after the date of diagnosis, reason not given G9353001003More than one ct scan of the paranasal sinuses ordered or received within 90 Medrsn >1 sinus ct w 90d dx 00 9 C M5B 1 02014010120140101 N G9353002004days after the date of diagnosis for documented reasons (eg, patients with G9353003004complications, second ct obtained prior to surgery, other medical reasons) G9354001003One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after 1 or no ct sinus w/in 90d dx00 9 C M5B 1 02014010120160101 N G9354002004the date of diagnosis G9355001003Elective delivery or early induction not performed No early ind/delivery 00 9 C M5B 1 02014010120140101 N G9356001003Elective delivery or early induction performed Early ind/delivery 00 9 C M5B 1 02014010120140101 N G9357001003Post-partum screenings, evaluations and education performed Pp eval/edu perf 00 9 C M5B 1 02014010120140101 N G9358001003Post-partum screenings, evaluations and education not performed Pp eval/edu not perf 00 9 C M5B 1 02014010120140101 N G9359001003Documentation of negative or managed positive tb screen with further evidence Doc of neg or man pos tb scn00 9 C M5B 1 02014010120170101 N G9359002004that tb is not active within one year of patient visit G9360001003No documentation of negative or managed positive tb screen No doc of neg or man pos tb 00 9 C M5B 1 02014010120140101 N G9361001003Medical indication for induction [documentation of reason(s) for elective Doc rsn elect c-sec/induct 00 9 C Z2 1 02014010120170101 N G9361002004delivery (c-section) or early induction (e.g., hemorrhage and placental G9361003004complications, hypertension, preeclampsia and eclampsia, rupture of G9361004004membranes-premature or prolonged, maternal conditions complicating G9361005004pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late G9361006004pregnancy, prior uterine surgery, or participation in clinical trial)] G9362001003Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) Mac or pnb w/o genanes >60m 00 9 C Z2 1 0201501012016010120151231N G9362002004without the use of general anesthesia during an applicable procedure 60 minutes G9362003004or longer, as documented in the anesthesia record G9363001003Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) Mac or pnb w/o genanes <60m 00 9 C Z2 1 0201501012016010120151231N G9363002004without the use of general anesthesia during an applicable procedure or general G9363003004or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia G9363004004record G9364001003Sinusitis caused by, or presumed to be caused by, bacterial infection Sinus caus bac inx 00 9 C Z2 1 02015010120150101 N G9365001003One high-risk medication ordered 1high risk med ord 00 9 C Z2 1 02015010120150101 N G9366001003One high-risk medication not ordered 1high risk no ord 00 9 C Z2 1 02015010120150101 N G9367001003At least two orders for the same high-risk medication >= 2 same hi-rsk med ord 00 9 C Z2 1 02015010120180101 N G9368001003At least two orders for the same high-risk medications not ordered >= 2 same hi-rsk med not ord00 9 C Z2 1 02015010120180101 N G9369001003Individual filled at least two prescriptions for any antipsychotic medication Fill 2 rx antipsych 00 9 C Z2 1 0201501012016010120151231N G9369002004and had a pdc of 0.8 or greater G9370001003Individual who did not fill at least two prescriptions for any antipsychotic Not fill 2 rx antipsych 00 9 C Z2 1 0201501012016010120151231N G9370002004medication or did not have a pdc of 0.8 or greater G9376001003Patient continued to have the retina attached at the 6 months follow up visit Contd ret attach at 6mth f/u00 9 C Z2 1 0201501012016010120151231N G9376002004(+/- 1 month) following only one surgery G9377001003Patient did not have the retina attached after 6 months following only one No ret attach after 6mt 00 9 C Z2 1 0201501012016010120151231N G9377002004surgery G9378001003Patient continued to have the retina attached at the 6 months follow up visit Contd ret attach f/u vis 00 9 C Z2 1 0201501012016010120151231N G9378002004(+/- 1 month) G9379001003Patient did not achieve flat retinas six months post surgery No acheive flat ret 6mth 00 9 C Z2 1 0201501012016010120151231N G9380001003Patient offered assistance with end of life issues during the measurement periodOff assis eol iss 00 9 C Z2 1 02015010120150101 N G9381001003Documentation of medical reason(s) for not offering assistance with end of life Doc med reas no offer eol 00 9 C Z2 1 0201501012018010120171231N G9381002004issues (e.g., patient in hospice care, patient in terminal phase) during the G9381003004measurement period G9382001003Patient not offered assistance with end of life issues during the measurement No off assis eol 00 9 C Z2 1 02015010120150101 N G9382002004period G9383001003Patient received screening for hcv infection within the 12 month reporting Recd scrn hcv infec 00 9 C Z2 1 02015010120150101 N G9383002004period G9384001003Documentation of medical reason(s) for not receiving annual screening for hcv Doc med rsn no hcv scrn 00 9 C Z2 1 02015010120180101 N G9384002004infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., G9384003004ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular G9384004004carcinoma, waitlist for organ transplant, limited life expectancy, other G9384005004medical reasons) G9385001003Documentation of patient reason(s) for not receiving annual screening for hcv Doc pt reas not rec hcv srn 00 9 C Z2 1 02015010120160101 N G9385002004infection (e.g., patient declined, other patient reasons) G9386001003Screening for hcv infection not received within the 12 month reporting period, Scrn hcv infec not recd 00 9 C Z2 1 02015010120150101 N G9386002004reason not given G9389001003Unplanned rupture of the posterior capsule requiring vitrectomy during cataract Unpln rup post cap 00 9 C Z2 1 02015010120160101 N G9389002004surgery G9390001003No unplanned rupture of the posterior capsule requiring vitrectomy during No unpln rup post cap 00 9 C Z2 1 02015010120160101 N G9390002004cataract surgery G9391001003Patient achieves refraction +-1 d for the eye that underwent cataract surgery, Achv refrac +1d 00 9 C Z2 1 0201501012016010120151231N G9391002004measured at the one month follow up visit G9392001003Patient does not achieve refraction +-1 d for the eye that underwent cataract Not achv refrac +1d 00 9 C Z2 1 0201501012016010120151231N G9392002004surgery, measured at the one month follow up visit G9393001003Patient with an initial phq-9 score greater than nine who achieves remission at Ini phq9 >9 remiss <5 00 9 C Z2 1 02015010120150101 N G9393002004twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of G9393003004less than five G9394001003Patient who had a diagnosis of bipolar disorder or personality disorder, death, Dx bipol, death, nhres, hosp00 9 C Z2 1 02015010120150101 N G9394002004permanent nursing home resident or receiving hospice or palliative care any G9394003004time during the measurement or assessment period G9395001003Patient with an initial phq-9 score greater than nine who did not achieve Ini phq9 >9 no remiss >=5 00 9 C Z2 1 02015010120150101 N G9395002004remission at twelve months as demonstrated by a twelve month (+/- 30 days) G9395003004phq-9 score greater than or equal to five G9396001003Patient with an initial phq-9 score greater than nine who was not assessed for Ini phq9 >9 not assess 00 9 C Z2 1 02015010120150101 N G9396002004remission at twelve months (+/- 30 days) G9399001003Documentation in the patient record of a discussion between the Doc disc tx choices 00 9 C Z2 1 02015010120150101 N G9399002004physician/clinician and the patient that includes all of the following: G9399003004treatment choices appropriate to genotype, risks and benefits, evidence of G9399004004effectiveness, and patient preferences toward the outcome of the treatment G9400001003Documentation of medical or patient reason(s) for not discussing treatment Doc reas no disc tx opt 00 9 C Z2 1 02015010120150101 N G9400002004options; medical reasons: patient is not a candidate for treatment due to G9400003004advanced physical or mental health comorbidity (including active substance G9400004004use); currently receiving antiviral treatment; successful antiviral treatment G9400005004(with sustained virologic response) prior to reporting period; other documented G9400006004medical reasons; patient reasons: patient unable or unwilling to participate in G9400007004the discussion or other patient reasons G9401001003No documentation of a discussion in the patient record of a discussion between No disc tx choices 00 9 C Z2 1 02015010120150101 N G9401002004the physician or other qualfied healthcare professional and the patient that G9401003004includes all of the following: treatment choices appropriate to genotype, risks G9401004004and benefits, evidence of effectiveness, and patient preferences toward G9401005004treatment G9402001003Patient received follow-up on the date of discharge or within 30 days after Recd f/u w/in 30d disch 00 9 C Z2 1 02015010120150101 N G9402002004discharge G9403001003Clinician documented reason patient was not able to complete 30 day follow-up Doc reas no 30 day f/u 00 9 C Z2 1 02015010120150101 N G9403002004from acute inpatient setting discharge (e.g., patient death prior to follow-up G9403003004visit, patient non-compliant for visit follow-up) G9404001003Patient did not receive follow-up on the date of discharge or within 30 days No 30 day f/u 00 9 C Z2 1 02015010120150101 N G9404002004after discharge G9405001003Patient received follow-up within 7 days from discharge Recd f/u w/in 7d disch 00 9 C Z2 1 02015010120150101 N G9406001003Clinician documented reason patient was not able to complete 7 day follow-up Doc reas no 7d f/u 00 9 C Z2 1 02015010120150101 N G9406002004from acute inpatient setting discharge (i.e patient death prior to follow-up G9406003004visit, patient non-compliance for visit follow-up) G9407001003Patient did not receive follow-up on or within 7 days after discharge No 7d f/u 00 9 C Z2 1 02015010120150101 N G9408001003Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 Card tamp w/in 30d 00 9 C Z2 1 02015010120150101 N G9408002004days G9409001003Patients without cardiac tamponade and/or pericardiocentesis occurring within No card tamp e/in 30d 00 9 C Z2 1 02015010120150101 N G940900200430 days G9410001003Patient admitted within 180 days, status post cied implantation, replacement, Admit w/in 180d req remov 00 9 C Z2 1 02015010120150101 N G9410002004or revision with an infection requiring device removal or surgical revision G9411001003Patient not admitted within 180 days, status post cied implantation, No admit w/in 180d req remov00 9 C Z2 1 02015010120150101 N G9411002004replacement, or revision with an infection requiring device removal or surgical G9411003004revision G9412001003Patient admitted within 180 days, status post cied implantation, replacement, Admit w/in 180d req surg rev00 9 C Z2 1 02015010120150101 N G9412002004or revision with an infection requiring device removal or surgical revision G9413001003Patient not admitted within 180 days, status post cied implantation, No admit req surg rev 00 9 C Z2 1 02015010120150101 N G9413002004replacement, or revision with an infection requiring device removal or surgical G9413003004revision G9414001003Patient had one dose of meningococcal vaccine on or between the patient's 11th 1dose menig vac btwn 11 & 1300 9 C Z2 1 02015010120150101 N G9414002004and 13th birthdays G9415001003Patient did not have one dose of meningococcal vaccine on or between the No 1dose meni vac btwn 11&1300 9 C Z2 1 02015010120150101 N G9415002004patient's 11th and 13th birthdays G9416001003Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine Pt 1 tdap betw 10-13 yrs 00 9 C Z2 1 02015010120170101 N G9416002004(tdap) on or between the patient's 10th and 13th birthdays G9417001003Patient did not have one tetanus, diphtheria toxoids and acellular pertussis Pt not 1 tdap betw 10-13 yrs00 9 C Z2 1 02015010120170101 N G9417002004vaccine (tdap) on or between the patient's 10th and 13th birthdays G9418001003Primary non-small cell lung cancer biopsy and cytology specimen report Lungcx bx rpt docs class 00 9 C Z2 1 02015010120150101 N G9418002004documents classification into specific histologic type or classified as G9418003004nsclc-nos with an explanation G9419001003Documentation of medical reason(s) for not including the histological type or Med reas not incl histo type00 9 C Z2 1 02015010120160101 N G9419002004nsclc-nos classification with an explanation (e.g., biopsy taken for other G9419003004purposes in a patient with a history of primary non-small cell lung cancer or G9419004004other documented medical reasons) G9420001003Specimen site other than anatomic location of lung or is not classified as Spec site no lung 00 9 C Z2 1 02015010120150101 N G9420002004primary non-small cell lung cancer G9421001003Primary non-small cell lung cancer biopsy and cytology specimen report does not Lung cx bx rpt no doc class 00 9 C Z2 1 02015010120150101 N G9421002004document classification into specific histologic type or classified as G9421003004nsclc-nos with an explanation G9422001003Primary lung carcinoma resection report documents pt category, pn category and Rpt doc class histo type 00 9 C Z2 1 02015010120150101 N G9422002004for non-small cell lung cancer, histologic type (squamous cell carcinoma, G9422003004adenocarcinoma and not nsclc-nos) G9423001003Documentation of medical reason for not including pt category, pn category and Med reas rpt no histo type 00 9 C Z2 1 02015010120150101 N G9423002004histologic type [for patient with appropriate exclusion criteria (e.g., G9423003004metastatic disease, benign tumors, malignant tumors other than carcinomas, G9423004004inadequate surgical specimens)] G9424001003Specimen site other than anatomic location of lung, or classified as nsclc-nos Site no lung or lung cx 00 9 C Z2 1 02015010120150101 N G9425001003Primary lung carcinoma resection report does not document pt category, pn Spec rpt no doc class histo 00 9 C Z2 1 02015010120150101 N G9425002004category and for non-small cell lung cancer, histologic type (squamous cell G9425003004carcinoma, adenocarcinoma) G9426001003Improvement in median time from ed arrival to initial ed oral or parenteral Impr med time edarr pain med00 9 C Z2 1 02015010120150101 N G9426002004pain medication administration performed for ed admitted patients G9427001003Improvement in median time from ed arrival to initial ed oral or parenteral No impro med time pain med 00 9 C Z2 1 02015010120150101 N G9427002004pain medication administration not performed for ed admitted patients G9428001003Pathology report includes the pt category and a statement on thickness, Patho rpt incl pt ctg 00 9 C Z2 1 02015010120190101 C G9428002004ulceration and mitotic rate G9429001003Documentation of medical reason(s) for not including pt category and a Doc med rsn no pt cat 00 9 C Z2 1 02015010120190101 C G9429002004statement on thickness, ulceration and mitotic rate (e.g., negative skin G9429003004biopsies in a patient with a history of melanoma or other documented medical G9429004004reasons) G9430001003Specimen site other than anatomic cutaneous location Spec site no cutaneous 00 9 C Z2 1 02015010120150101 N G9431001003Pathology report does not include the pt category and a statement on thickness, Patho rpt no pt ctg 00 9 C Z2 1 02015010120190101 C G9431002004ulceration and mitotic rate G9432001003Asthma well-controlled based on the act, c-act, acq, or ataq score and results Asth controlled 00 9 C Z2 1 02015010120150101 N G9432002004documented G9433001003Death, permanent nursing home resident or receiving hospice or palliative care Death, nhres, hospice 00 9 C Z2 1 0201501012016010120151231N G9433002004any time during the measurement period G9434001003Asthma not well-controlled based on the act, c-act, acq, or ataq score, or Asth not controlled 00 9 C Z2 1 02015010120150101 N G9434002004specified asthma control tool not used, reason not given G9435001003Aspirin prescribed at discharge Asp presc disch 00 9 C Z2 1 0201501012017010120161231N G9436001003Aspirin not prescribed for documented reasons (e.g., allergy, medical Asp not presc doc reas 00 9 C Z2 1 0201501012017010120161231N G9436002004intolerance, history of bleed) G9437001003Aspirin not prescribed at discharge Asp not presc disch 00 9 C Z2 1 0201501012017010120161231N G9438001003P2y inhibitor prescribed at discharge P2y inhib presc 00 9 C Z2 1 0201501012017010120161231N G9439001003P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical P2y inhib not presc doc reas00 9 C Z2 1 0201501012017010120161231N G9439002004intolerance, history of bleed) G9440001003P2y inhibitor not prescribed at discharge P2y inhib not presc 00 9 C Z2 1 0201501012017010120161231N G9441001003Statin prescribed at discharge Statin presc disch 00 9 C Z2 1 0201501012017010120161231N G9442001003Statin not prescribed for documented reasons (e.g., allergy, medical Statin not presc doc reas 00 9 C Z2 1 0201501012017010120161231N G9442002004intolerance) G9443001003Statin not prescribed at discharge Statin not presc disch 00 9 C Z2 1 0201501012017010120161231N G9448001003Patients who were born in the years 1945?1965 Born 1945-1965 00 9 C Z2 1 02015010120150101 N G9449001003History of receiving blood transfusions prior to 1992 Hx bld transf b/f 1992 00 9 C Z2 1 02015010120150101 N G9450001003History of injection drug use Hx injec drug use 00 9 C Z2 1 02015010120150101 N G9451001003Patient received one-time screening for hcv infection 1x scrn hcv infect 00 9 C Z2 1 02015010120150101 N G9452001003Documentation of medical reason(s) for not receiving one-time screening for hcv Doc med reas no scrn hcv 00 9 C Z2 1 02015010120150101 N G9452002004infection (e.g., decompensated cirrhosis indicating advanced disease [ie, G9452003004ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular G9452004004carcinoma, waitlist for organ transplant, limited life expectancy, other G9452005004medical reasons) G9453001003Documentation of patient reason(s) for not receiving one-time screening for hcv Pt reas no hcv infect 00 9 C Z2 1 02015010120150101 N G9453002004infection (e.g., patient declined, other patient reasons) G9454001003One-time screening for hcv infection not received within 12-month reporting No scr hcv inf 12 mth rp 00 9 C Z2 1 02015010120190101 C G9454002004period and no documentation of prior screening for hcv infection, reason not G9454003004given G9455001003Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or Abd imag w/us, ct or mri 00 9 C Z2 1 02015010120150101 N G9455002004contrast mri for hcc G9456001003Documentation of medical or patient reason(s) for not ordering or performing Doc med pt reas no hcc scrn 00 9 C Z2 1 02015010120150101 N G9456002004screening for hcc. medical reason: comorbid medical conditions with expected G9456003004survival < 5 years, hepatic decompensation and not a candidate for liver G9456004004transplantation, or other medical reasons; patient reasons: patient declined or G9456005004other patient reasons (e.g., cost of tests, time related to accessing testing G9456006004equipment) G9457001003Patient did not undergo abdominal imaging and did not have a documented reason Pt no abd img no doc rsn 00 9 C Z2 1 02015010120190101 C G9457002004for not undergoing abdominal imaging in the submission period G9458001003Patient documented as tobacco user and received tobacco cessation intervention Tob user recd cess interv 00 9 C Z2 1 02015010120150101 N G9458002004(must include at least one of the following: advice given to quit smoking or G9458003004tobacco use, counseling on the benefits of quitting smoking or tobacco use, G9458004004assistance with or referral to external smoking or tobacco cessation support G9458005004programs, or current enrollment in smoking or tobacco use cessation program) if G9458006004identified as a tobacco user G9459001003Currently a tobacco non-user Tob non-user 00 9 C Z2 1 02015010120150101 N G9460001003Tobacco assessment or tobacco cessation intervention not performed, reason not No tob assess or cess inter 00 9 C Z2 1 02015010120160101 N G9460002004given G9463001003I intend to report the sinusitis measures group Sinusitis intent 00 9 C Z2 1 0201501012017010120161231N G9464001003All quality actions for the applicable measures in the sinusitis measures group Sinusitis comp 00 9 C Z2 1 0201501012017010120161231N G9464002004have been performed for this patient G9465001003I intend to report the acute otitis externa (aoe) measures group Aoe intent 00 9 C Z2 1 0201501012017010120161231N G9466001003All quality actions for the applicable measures in the aoe measures group have Aoe comp 00 9 C Z2 1 0201501012017010120161231N G9466002004been performed for this patient G9467001003Patient who have received or are receiving corticosteroids greater than or Recd cortico >=10mg/day >60d00 9 C Z2 1 0201501012017010120161231N G9467002004equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days G9467003004or a single prescription equating to 600 mg prednisone or greater for all fills G9467004004within the last twelve months G9468001003Patient not receiving corticosteroids greater than or equal to 10 mg/day of No recd cortico>=10mg/d >60d00 9 C Z2 1 02015010120150101 N G9468002004prednisone equivalents for 60 or greater consecutive days or a single G9468003004prescription equating to 600 mg prednisone or greater for all fills G9469001003Patients who have received or are receiving corticosteroids greater than or Rec cortico>60d or 1rx 600mg00 9 C Z2 1 02015010120150101 N G9469002004equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days G9469003004or a single prescription equating to 600 mg prednisone or greater for all fills G9470001003Patients not receiving corticosteroids greater than or equal to 10 mg/day of No rec cortico>60d 1rx 600mg00 9 C Z2 1 02015010120150101 N G9470002004prednisone equivalents for 60 or greater consecutive days or a single G9470003004prescription equating to 600 mg prednisone or greater for all fills G9471001003Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not W/in 2yr dxa not order 00 9 C Z2 1 02015010120150101 N G9471002004ordered or documented G9472001003Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not No dxa no med hx no rv sx 00 9 C Z2 1 02015010120150101 N G9472002004ordered and documented, no review of systems and no medication history or G9472003004pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed G9473001003Services performed by chaplain in the hospice setting, each 15 minutes Chap services at hospice 00 9 C M5D 1 02016010120160101 N G9474001003Services performed by dietary counselor in the hospice setting, each 15 minutes Diet counsel at hospice 00 9 C M5D 1 02016010120160101 N G9475001003Services performed by other counselor in the hospice setting, each 15 minutes Other counselor at hospice 00 9 C M5D 1 02016010120160101 N G9476001003Services performed by volunteer in the hospice setting, each 15 minutes Volun service at hospice 00 9 C M5D 1 02016010120160101 N G9477001003Services performed by care coordinator in the hospice setting, each 15 minutes Care coord at hospice 00 9 C M5D 1 02016010120160101 N G9478001003Services performed by other qualified therapist in the hospice setting, each 15 Othe therapist at hospice 00 9 C M5D 1 02016010120160101 N G9478002004minutes G9479001003Services performed by qualified pharmacist in the hospice setting, each 15 Pharmacist at hospice 00 9 C M5D 1 02016010120160101 N G9479002004minutes G9480001003Admission to medicare care choice model program (mccm) Admission to mccm 00 9 C M5D 1 02016010120160101 N G9481001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 10mins 00 9 C 0206Z2 1 02016040120180101 N G9481002004only in a medicare-approved cms innovation center demonstration project, which G9481003004requires these 3 key components: a problem focused history; a problem focused G9481004004examination; and straightforward medical decision making, furnished in real G9481005004time using interactive audio and video technology. counseling and coordination G9481006004of care with other physicians, other qualified health care professionals or G9481007004agencies are provided consistent with the nature of the problem(s) and the G9481008004needs of the patient or the family or both. usually, the presenting problem(s) G9481009004are self limited or minor. typically, 10 minutes are spent with the patient or G9481010004family or both via real time, audio and video intercommunications technology G9482001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 20mins 00 9 C 0206Z2 1 02016040120180101 N G9482002004only in a medicare-approved cms innovation center demonstration project, which G9482003004requires these 3 key components: an expanded problem focused history; an G9482004004expanded problem focused examination; straightforward medical decision making, G9482005004furnished in real time using interactive audio and video technology. G9482006004counseling and coordination of care with other physicians, other qualified G9482007004health care professionals or agencies are provided consistent with the nature G9482008004of the problem(s) and the needs of the patient or the family or both. usually, G9482009004the presenting problem(s) are of low to moderate severity. typically, 20 G9482010004minutes are spent with the patient or family or both via real time, audio and G9482011004video intercommunications technology G9483001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 30mins 00 9 C 0206Z2 1 02016040120180101 N G9483002004only in a medicare-approved cms innovation center demonstration project, which G9483003004requires these 3 key components: a detailed history; a detailed examination; G9483004004medical decision making of low complexity, furnished in real time using G9483005004interactive audio and video technology. counseling and coordination of care G9483006004with other physicians, other qualified health care professionals or agencies G9483007004are provided consistent with the nature of the problem(s) and the needs of the G9483008004patient or the family or both. usually, the presenting problem(s) are of G9483009004moderate severity. typically, 30 minutes are spent with the patient or family G9483010004or both via real time, audio and video intercommunications technology G9484001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 45mins 00 9 C 0206Z2 1 02016040120180101 N G9484002004only in a medicare-approved cms innovation center demonstration project, which G9484003004requires these 3 key components: a comprehensive history; a comprehensive G9484004004examination; medical decision making of moderate complexity, furnished in real G9484005004time using interactive audio and video technology. counseling and coordination G9484006004of care with other physicians, other qualified health care professionals or G9484007004agencies are provided consistent with the nature of the problem(s) and the G9484008004needs of the patient or the family or both. usually, the presenting problem(s) G9484009004are of moderate to high severity. typically, 45 minutes are spent with the G9484010004patient or family or both via real time, audio and video intercommunications G9484011004technology G9485001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 60mins 00 9 C 0206Z2 1 02016040120180101 N G9485002004only in a medicare-approved cms innovation center demonstration project, which G9485003004requires these 3 key components: a comprehensive history; a comprehensive G9485004004examination; medical decision making of high complexity, furnished in real time G9485005004using interactive audio and video technology. counseling and coordination of G9485006004care with other physicians, other qualified health care professionals or G9485007004agencies are provided consistent with the nature of the problem(s) and the G9485008004needs of the patient or the family or both. usually, the presenting problem(s) G9485009004are of moderate to high severity. typically, 60 minutes are spent with the G9485010004patient or family or both via real time, audio and video intercommunications G9485011004technology G9486001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 10mins 00 9 C 0206Z2 1 02016040120180101 N G9486002004patient for use only in a medicare-approved cms innovation center demonstration G9486003004project, which requires at least 2 of the following 3 key components: a problem G9486004004focused history; a problem focused examination; straightforward medical G9486005004decision making, furnished in real time using interactive audio and video G9486006004technology. counseling and coordination of care with other physicians, other G9486007004qualified health care professionals or agencies are provided consistent with G9486008004the nature of the problem(s) and the needs of the patient or the family or G9486009004both. usually, the presenting problem(s) are self limited or minor. G9486010004typically, 10 minutes are spent with the patient or family or both via real G9486011004time, audio and video intercommunications technology G9487001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 15mins 00 9 C 0206Z2 1 02016040120180101 N G9487002004patient for use only in a medicare-approved cms innovation center demonstration G9487003004project, which requires at least 2 of the following 3 key components: an G9487004004expanded problem focused history; an expanded problem focused examination; G9487005004medical decision making of low complexity, furnished in real time using G9487006004interactive audio and video technology. counseling and coordination of care G9487007004with other physicians, other qualified health care professionals or agencies G9487008004are provided consistent with the nature of the problem(s) and the needs of the G9487009004patient or the family or both. usually, the presenting problem(s) are of low G9487010004to moderate severity. typically, 15 minutes are spent with the patient or G9487011004family or both via real time, audio and video intercommunications technology G9488001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 25mins 00 9 C 0206Z2 1 02016040120180101 N G9488002004patient for use only in a medicare-approved cms innovation center demonstration G9488003004project, which requires at least 2 of the following 3 key components: a G9488004004detailed history; a detailed examination; medical decision making of moderate G9488005004complexity, furnished in real time using interactive audio and video G9488006004technology. counseling and coordination of care with other physicians, other G9488007004qualified health care professionals or agencies are provided consistent with G9488008004the nature of the problem(s) and the needs of the patient or the family or G9488009004both. usually, the presenting problem(s) are of moderate to high severity. G9488010004typically, 25 minutes are spent with the patient or family or both via real G9488011004time, audio and video intercommunications technology G9489001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 40mins 00 9 C 0206Z2 1 02016040120180101 N G9489002004patient for use only in a medicare-approved coms innovation center G9489003004demonstration project, which requires at least 2 of the following 3 key G9489004004components: a comprehensive history; a comprehensive examination; medical G9489005004decision making of high complexity, furnished in real time using interactive G9489006004audio and video technology. counseling and coordination of care with other G9489007004physicians, other qualified health care professionals or agencies are provided G9489008004consistent with the nature of the problem(s) and the needs of the patient or G9489009004the family or both. usually, the presenting problem(s) are of moderate to high G9489010004severity. typically, 40 minutes are spent with the patient or family or both G9489011004via real time, audio and video intercommunications technology G9490001003Cms innovation center models, home visit for patient assessment performed by Cmmi mod home visit 00 9 C 0206Z2 1 02016040120180101 N G9490002004clinical staff for an individual not considered homebound, including, but not G9490003004necessarily limited to patient assessment of clinical status, safety/fall G9490004004prevention, functional status/ambulation, medication reconciliation/management, G9490005004compliance with orders/plan of care, performance of activities of daily living, G9490006004and ensuring beneficiary connections to community and other services. (for use G9490007004only in medicare-approved cms innovation center models); may not be billed for G9490008004a 30 day period covered by a transitional care management code G9496001003Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., Doc rsn no adeno/neopl detec00 9 C Z2 1 0201601012018010120171231N G9496002004neoplasm detected is only diagnosed as traditional serrated adenoma, sessile G9496003004serrated polyp, or sessile serrated adenoma G9497001003Received instruction from the anesthesiologist or proxy prior to the day of Rec inst no smoke day surg 00 9 C Z2 1 02016010120170101 N G9497002004surgery to abstain from smoking on the day of surgery G9498001003Antibiotic regimen prescribed Abx reg prescribed 00 9 C Z2 1 02016010120160101 N G9499001003Patient did not start or is not receiving antiviral treatment for hepatitis c No start/rec antvir tx hep c00 9 C Z2 1 0201601012017010120161231N G9499002004during the measurement period G9500001003Radiation exposure indices, or exposure time and number of fluorographic images Rad expos ind/exp tm doc 00 9 C Z2 1 02016010120170101 N G9500002004in final report for procedures using fluoroscopy, documented G9501001003Radiation exposure indices, or exposure time and number of fluorographic images Rad expos ind/exp tm no doc 00 9 C Z2 1 02016010120170101 N G9501002004not documented in final report for procedure using fluoroscopy, reason not given G9502001003Documentation of medical reason for not performing foot exam (i.e., patients Med reas no perf foot exam 00 9 C Z2 1 02016010120160101 N G9502002004who have had either a bilateral amputation above or below the knee, or both a G9502003004left and right amputation above or below the knee before or during the G9502004004measurement period) G9503001003Patient taking tamsulosin hydrochloride Pt tk tams hcl 00 9 C Z2 1 02016010120160101 N G9504001003Documented reason for not assessing hepatitis b virus (hbv) status (e.g., Doc rsn hep b stat not asses00 9 C Z2 1 02016010120180101 N G9504002004patient not initiating anti-tnf therapy, patient declined) prior to initiating G9504003004anti-tnf therapy G9505001003Antibiotic regimen prescribed within 10 days after onset of symptoms for Abx pres w/in 10 dys of symp00 9 C Z2 1 02016010120160101 N G9505002004documented medical reason G9506001003Biologic immune response modifier prescribed Bio imm resp mod presc 00 9 C Z2 1 02016010120160101 N G9507001003Documentation that the patient is on a statin medication or has documentation Doc reas on statin or contra00 9 C Z2 1 02016010120160101 N G9507002004of a valid contraindication or exception to statin medications; G9507003004contraindications/exceptions that can be defined by diagnosis codes include G9507004004pregnancy during the measurement period, active liver disease, rhabdomyolysis, G9507005004end stage renal disease on dialysis and heart failure; provider documented G9507006004contraindications/exceptions include breastfeeding during the measurement G9507007004period, woman of child-bearing age not actively taking birth control, allergy G9507008004to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, G9507009004gemfibrozil, and danazol) and intolerance (with supporting documentation of G9507010004trying a statin at least once within the last 5 years or diagnosis codes for G9507011004myostitis or toxic myopathy related to drugs) G9508001003Documentation that the patient is not on a statin medication Doc pt not on statin 00 9 C Z2 1 02016010120160101 N G9509001003Adult patients 18 years of age or older with major depression or dysthymia who Adit mdd dys rem 12 mnths 00 9 C Z2 1 02016010120190101 C G9509002004reached remission at twelve months as demonstrated by a twelve month (+/-60 G9509003004days) phq-9 or phq-9m score of less than 5 G9510001003Remission at twelve months not demonstrated by a twelve month (+/-30 days) Remis 12m not phq-9 score <500 9 C Z2 1 02016010120160101 N G9510002004phq-9 score of less than five; either phq-9 score was not assessed or is G9510003004greater than or equal to 5 G9511001003Index event date phq-9 or phq-9m score greater than 9 documented during the Idx evt dte phq>9 doc 12 mo 00 9 C Z2 1 02016010120190101 C G9511002004twelve month denominator identification period G9512001003Individual had a pdc of 0.8 or greater Indiv pdc > 0.8 00 9 C Z2 1 02016010120160101 N G9513001003Individual did not have a pdc of 0.8 or greater Indiv pdc not > 0.8 00 9 C Z2 1 02016010120160101 N G9514001003Patient required a return to the operating room within 90 days of surgery Req ret or w/in 90d of surg 00 9 C Z2 1 02016010120160101 N G9515001003Patient did not require a return to the operating room within 90 days of surgeryNo reas, no ret or w/in 90d 00 9 C Z2 1 02016010120160101 N G9516001003Patient achieved an improvement in visual acuity, from their preoperative Impr vis acuit w/in 90d 00 9 C Z2 1 02016010120160101 N G9516002004level, within 90 days of surgery G9517001003Patient did not achieve an improvement in visual acuity, from their No impr vis acuit w/in 90d 00 9 C Z2 1 02016010120160101 N G9517002004preoperative level, within 90 days of surgery, reason not given G9518001003Documentation of active injection drug use Doc active inj drug use 00 9 C Z2 1 02016010120160101 N G9519001003Patient achieves final refraction (spherical equivalent) +/- 0.5 diopters of Final ref +/- 0.5 w/in 90d 00 9 C Z2 1 02016010120170101 N G9519002004their planned refraction within 90 days of surgery G9520001003Patient does not achieve final refraction (spherical equivalent) +/- 0.5 Refract not +/- 0.5 w/in 90d00 9 C Z2 1 02016010120170101 N G9520002004diopters of their planned refraction within 90 days of surgery G9521001003Total number of emergency department visits and inpatient hospitalizations less Er and ip hosp <2 in 12 mos 00 9 C Z2 1 02016010120160101 N G9521002004than two in the past 12 months G9522001003Total number of emergency department visits and inpatient hospitalizations Er/ip hosp =/>2 in 12 mos 00 9 C Z2 1 02016010120160101 N G9522002004equal to or greater than two in the past 12 months or patient not screened, G9522003004reason not given G9523001003Patient discontinued from hemodialysis or peritoneal dialysis D/c hemo or perit dialysis 00 9 C Z2 1 02016010120160101 N G9524001003Patient was referred to hospice care Refer to hospice 00 9 C Z2 1 02016010120160101 N G9525001003Documentation of patient reason(s) for not referring to hospice care (e.g., Doc pt reas no hospice refer00 9 C Z2 1 02016010120160101 N G9525002004patient declined, other patient reasons) G9526001003Patient was not referred to hospice care, reason not given No reason, no refer hospice 00 9 C Z2 1 02016010120160101 N G9529001003Patient with minor blunt head trauma had an appropriate indication(s) for a Minor blunt trauma w/head ct00 9 C Z2 1 02016010120160101 N G9529002004head ct G9530001003Patient presented with a minor blunt head trauma and had a head ct ordered for Pt mbht hd ct ord ec prov 00 9 C Z2 1 02016010120190101 C G9530002004trauma by an emergency care provider G9531001003Patient has documentation of ventricular shunt, brain tumor, multisystem Pt doc 00 9 C Z2 1 02016010120190101 C G9531002004trauma, pregnancy, or is currently taking an antiplatelet medication including: G9531003004abciximab, cangrelor, cilostazol, clopidogrel, eptifibatide, prasugrel, G9531004004ticlopidine, ticagrelor, tirofiban, or vorapaxar G9532001003Patient had a head ct for trauma ordered by someone other than an emergency Pt hd ct ord 00 9 C Z2 1 02016010120190101 C G9532002004care provider or was ordered for a reason other than trauma G9533001003Patient with minor blunt head trauma did not have an appropriate indication(s) Indic for head ct not valid 00 9 C Z2 1 02016010120160101 N G9533002004for a head ct G9534001003Advanced brain imaging (cta, ct, mra or mri) was not ordered Adv brain image not ordered 00 9 C Z2 1 0201601012019010120181231D G9535001003Patients with a normal neurological examination Normal neuro exam 00 9 C Z2 1 0201601012019010120181231D G9536001003Documentation of medical reason(s) for ordering an advanced brain imaging study Doc med reas adv brain image00 9 C Z2 1 0201601012019010120181231D G9536002004(i.e., patient has an abnormal neurological examination; patient has the G9536003004coexistence of seizures, or both; recent onset of severe headache; change in G9536004004the type of headache; signs of increased intracranial pressure (e.g., G9536005004papilledema, absent venous pulsations on funduscopic examination, altered G9536006004mental status, focal neurologic deficits, signs of meningeal irritation); G9536007004hiv-positive patients with a new type of headache; immunocompromised patient G9536008004with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or G9536009004anti-platelet therapy; very young patients with unexplained headache symptoms) G9537001003Documentation of system reason(s) for obtaining imaging of the head (ct or mri) Doc sysm rsn img hd 00 9 C Z2 1 02016010120190101 C G9537002004(i.e., needed as part of a clinical trial; other clinician ordered the study) G9538001003Advanced brain imaging (cta, ct, mra or mri) was ordered Adv brain image ordered 00 9 C Z2 1 0201601012019010120181231D G9539001003Intent for potential removal at time of placement Intent pot remv time placemt00 9 C Z2 1 02016010120160101 N G9540001003Patient alive 3 months post procedure Pt alive 3 mos post proc 00 9 C Z2 1 02016010120160101 N G9541001003Filter removed within 3 months of placement Filter rem 3 mon plmt 00 9 C Z2 1 02016010120180101 N G9542001003Documented re-assessment for the appropriateness of filter removal within 3 Doc reass appr remo filt 3ms00 9 C Z2 1 02016010120160101 N G9542002004months of placement G9543001003Documentation of at least two attempts to reach the patient to arrange a Doc 2x re-assess filt remov 00 9 C Z2 1 02016010120160101 N G9543002004clinical re-assessment for the appropriateness of filter removal within 3 G9543003004months of placement G9544001003Patients that do not have the filter removed, documented re-assessment for the No filt remov w/in 3mos plcm00 9 C Z2 1 02016010120160101 N G9544002004appropriateness of filter removal, or documentation of at least two attempts to G9544003004reach the patient to arrange a clinical re-assessment for the appropriateness G9544004004of filter removal within 3 months of placement G9547001003Incidental finding: liver lesion <= 0.5 cm, cystic kidney lesion < 1.0 cm or Incid finding liver/kid/adre00 9 C Z2 1 02016010120170101 N G9547002004adrenal lesion <= 1.0 cm G9548001003Final reports for abdominal imaging studies with follow-up imaging recommended Abd imag and followup rec 00 9 C Z2 1 02016010120160101 N G9549001003Documentation of medical reason(s) that follow-up imaging is indicated (e.g., Doc med rsn for follow imag 00 9 C Z2 1 02016010120170101 N G9549002004patient has a known malignancy that can metastasize, other medical reason(s) G9549003004such as fever in an immunocompromised patient) G9550001003Final reports for abdominal imaging studies with follow-up imaging not Abd imag and followup no rec00 9 C Z2 1 02016010120160101 N G9550002004recommended G9551001003Final reports for abdominal imaging studies without an incidentally found Abd imag no les,kid/livr/adr00 9 C Z2 1 02016010120170101 N G9551002004lesion noted: liver lesion <= 0.5 cm, cystic kidney lesion < 1.0 cm or adrenal G9551003004lesion <= 1.0 cm noted or no lesion found G9552001003Incidental thyroid nodule < 1.0 cm noted in report Inc thyr node <1.0 in rpt 00 9 C Z2 1 02016010120160101 N G9553001003Prior thyroid disease diagnosis Prior thyroid dise dx 00 9 C Z2 1 02016010120160101 N G9554001003Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the Ct/cta/mri/a chst foll rec 00 9 C Z2 1 02016010120170101 N G9554002004neck with follow-up imaging recommended G9555001003Documentation of medical reason(s) for recommending follow up imaging (e.g., Doc med rsn for follup image00 9 C Z2 1 02016010120170101 N G9555002004patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, G9555003004other medical reason(s)) G9556001003Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the Ct/cta/mri/a no follup imag 00 9 C Z2 1 02016010120170101 N G9556002004neck with follow-up imaging not recommended G9557001003Final reports for ct, cta, mri or mra studies of the chest or neck or Ct/cta/mri/a no thyr <1.0cm 00 9 C Z2 1 02016010120170101 N G9557002004ultrasound of the neck without an incidentally found thyroid nodule < 1.0 cm G9557003004noted or no nodule found G9558001003Patient treated with a beta-lactam antibiotic as definitive therapy Tx beta-lactam abx therapy 00 9 C Z2 1 02016010120160101 N G9559001003Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic Doc med reas no abx therapy 00 9 C Z2 1 02016010120160101 N G9559002004(e.g., allergy, intolerance to beta-lactam antibiotics) G9560001003Patient not treated with a beta-lactam antibiotic as definitive therapy, reason No beta-lactam abx ther, rng00 9 C Z2 1 02016010120160101 N G9560002004not given G9561001003Patients prescribed opiates for longer than six weeks Presc opiates >6 wks 00 9 C Z2 1 02016010120160101 N G9562001003Patients who had a follow-up evaluation conducted at least every three months Foll-up eval q3mo opiod tx 00 9 C Z2 1 02016010120160101 N G9562002004during opioid therapy G9563001003Patients who did not have a follow-up evaluation conducted at least every three No f/u eval q3mo opiod tx 00 9 C Z2 1 02016010120160101 N G9563002004months during opioid therapy G9572001003Index date phq-score greater than 9 documented during the twelve month Phq-scr >9 doc in 12m time 00 9 C Z2 1 0201601012017010120161231N G9572002004denominator identification period G9573001003Adult patients 18 years of age or older with major depression or dysthymia who Adl pt md or dys rem 6 mon 00 9 C Z2 1 02016010120190101 C G9573002004did not reach remission at six months as demonstrated by a six month (+/-60 G9573003004days) phq-9 or phq-9m score of less than five G9574001003Adult patients 18 years of age or older with major depression or dysthymia who Adl pt md dys no rem 6 mon 00 9 C Z2 1 02016010120190101 C G9574002004did not reach remission at six months as demonstrated by a six month (+/-60 G9574003004days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was G9574004004not assessed or is greater than or equal to five G9577001003Patients prescribed opiates for longer than six weeks Presc opiates >6 wks 00 9 C Z2 1 02016010120160101 N G9578001003Documentation of signed opioid treatment agreement at least once during opioid Doc opioid tx 1x during ther00 9 C Z2 1 02016010120160101 N G9578002004therapy G9579001003No documentation of signed an opioid treatment agreement at least once during No doc opioid tx 1x at ther 00 9 C Z2 1 02016010120160101 N G9579002004opioid therapy G9580001003Door to puncture time of less than 2 hours Door to punc time <2hrs 00 9 C Z2 1 02016010120160101 N G9581001003Door to puncture time of greater than 2 hours for reasons documented by Md doc, door to punc tm >2hr00 9 C Z2 1 0201601012017010120161231N G9581002004clinician (e.g., patients who are transferred from one institution to another G9581003004with a known diagnosis of cva for endovascular stroke treatment; hospitalized G9581004004patients with newly diagnosed cva considered for endovascular stroke treatment) G9582001003Door to puncture time of greater than 2 hours, no reason given Door to punc time >2hr, nrg 00 9 C Z2 1 02016010120160101 N G9583001003Patients prescribed opiates for longer than six weeks Presc opiates >6 wks 00 9 C Z2 1 02016010120160101 N G9584001003Patient evaluated for risk of misuse of opiates by using a brief validated Eval opioid use instr/pt int00 9 C Z2 1 02016010120170101 N G9584002004instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least G9584003004once during opioid therapy G9585001003Patient not evaluated for risk of misuse of opiates by using a brief validated No eval opi use instr/intv 00 9 C Z2 1 02016010120170101 N G9585002004instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at G9585003004least once during opioid therapy G9593001003Pediatric patient with minor blunt head trauma classified as low risk according Low pecarn ped head trauma 00 9 C Z2 1 02016010120160101 N G9593002004to the pecarn prediction rules G9594001003Patient presented with a minor blunt head trauma and had a head ct ordered for Pt mbht hd ct ord ec prov 00 9 C Z2 1 02016010120190101 C G9594002004trauma by an emergency care provider G9595001003Patient has documentation of ventricular shunt, brain tumor, coagulopathy, Doc shnt/tum/coag/thrombocyt00 9 C Z2 1 02016010120170101 N G9595002004including thrombocytopenia G9596001003Pediatric patient had a head ct for trauma ordered by someone other than an Ped pt hd ct ord 00 9 C Z2 1 02016010120190101 C G9596002004emergency care provider or was ordered for a reason other than trauma G9597001003Pediatric patient with minor blunt head trauma not classified as low risk No low pecarn ped head traum00 9 C Z2 1 02016010120160101 N G9597002004according to the pecarn prediction rules G9598001003Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or Aor ane 5.5-5.9 cm max diam 00 9 C Z2 1 02016010120160101 N G9598002004minor diameter on axial formatted ct G9599001003Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct Aor ane >=6.0 cm max diam 00 9 C Z2 1 02016010120160101 N G9599002004or minor diameter on axial formatted ct G9600001003Symptomatic aaas that required urgent/emergent (non-elective) repair Symp aaa urgent repair 00 9 C Z2 1 02016010120160101 N G9601001003Patient discharge to home no later than post-operative day #7 Pt dchg home post op day 7 00 9 C Z2 1 02016010120160101 N G9602001003Patient not discharged to home by post-operative day #7 Pt no dchg home postop day 700 9 C Z2 1 02016010120160101 N G9603001003Patient survey score improved from baseline following treatment Pt surv improv bsline tx 00 9 C Z2 1 02016010120160101 N G9604001003Patient survey results not available Pt surv results not avail 00 9 C Z2 1 02016010120160101 N G9605001003Patient survey score did not improve from baseline following treatment Surv score no improv w/tx 00 9 C Z2 1 02016010120160101 N G9606001003Intraoperative cystoscopy performed to evaluate for lower tract injury Intraop cyst eval trac inj 00 9 C Z2 1 02016010120160101 N G9607001003Documented medical reasons for not performing intraoperative cystoscopy (e.g., Doc med rsn not perf cystosc00 9 C Z2 1 02016010120180101 N G9607002004urethral pathology precluding cystoscopy, any patient who has a congenital or G9607003004acquired absence of the urethra) or in the case of patient death G9608001003Intraoperative cystoscopy not performed to evaluate for lower tract injury Intraop cyst eval not done 00 9 C Z2 1 02016010120160101 N G9609001003Documentation of an order for anti-platelet agents Doc order anti-plat 00 9 C Z2 1 02016010120170101 N G9610001003Documentation of medical reason(s) in the patient's record for not ordering Doc md rsn no antipla 00 9 C Z2 1 02016010120170101 N G9610002004anti-platelet agents G9611001003Order for anti-platelet agents was not documented in the patient's record, No doc order anti-plat rng 00 9 C Z2 1 02016010120170101 N G9611002004reason not given G9612001003Photodocumentation of two or more cecal landmarks to establish a complete Phodoc 2 mr cec lndmk 00 9 C Z2 1 02016010120190101 C G9612002004examination G9613001003Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal Doc post surg anatomy 00 9 C Z2 1 02016010120160101 N G9613002004resection, etc.) G9614001003Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks Photodoc < 2 cec lndmk 00 9 C Z2 1 02016010120190101 C G9614002004or only one cecal landmark) to establish a complete examination G9615001003Preoperative assessment documented Pre-op asst doc 00 9 C Z2 1 02016010120160101 N G9616001003Documentation of reason(s) for not documenting a preoperative assessment (e.g., Doc rsn no preop assmt 00 9 C Z2 1 02016010120160101 N G9616002004patient with a gynecologic or other pelvic malignancy noted at the time of G9616003004surgery) G9617001003Preoperative assessment not documented, reason not given Pre-op asst not doc, rng 00 9 C Z2 1 02016010120160101 N G9618001003Documentation of screening for uterine malignancy or those that had an Doc scr uter mal or us/samp 00 9 C Z2 1 02016010120160101 N G9618002004ultrasound and/or endometrial sampling of any kind G9619001003Documentation of reason(s) for not screening for uterine malignancy (e.g., Doc rsn no scr uter malig 00 9 C Z2 1 0201601012017010120161231N G9619002004prior hysterectomy) G9620001003Patient not screened for uterine malignancy, or those that have not had an No scr utr malig/us/samp rng00 9 C Z2 1 02016010120160101 N G9620002004ultrasound and/or endometrial sampling of any kind, reason not given G9621001003Patient identified as an unhealthy alcohol user when screened for unhealthy Scr unheal etoh w/counsel 00 9 C Z2 1 02016010120160101 N G9621002004alcohol use using a systematic screening method and received brief counseling G9622001003Patient not identified as an unhealthy alcohol user when screened for unhealthy No unheal etoh user 00 9 C Z2 1 02016010120160101 N G9622002004alcohol use using a systematic screening method G9623001003Documentation of medical reason(s) for not screening for unhealthy alcohol use Doc med rsn no scr etoh use 00 9 C Z2 1 02016010120160101 N G9623002004(e.g., limited life expectancy, other medical reasons) G9624001003Patient not screened for unhealthy alcohol use using a systematic screening Pt not scrn or no counseling00 9 C Z2 1 02016010120180101 N G9624002004method or patient did not receive brief counseling if identified as an G9624003004unhealthy alcohol user, reason not given G9625001003Patient sustained bladder injury at the time of surgery or discovered Pt bl srg 30 day pst srg 00 9 C Z2 1 02016010120190101 C G9625002004subsequently up to 30 days post-surgery G9626001003Documented medical reason for not reporting bladder injury (e.g., gynecologic Med rsn no rpt baldder inj 00 9 C Z2 1 02016010120170101 N G9626002004or other pelvic malignancy documented, concurrent surgery involving bladder G9626003004pathology, injury that occurs during urinary incontinence procedure, patient G9626004004death from non-medical causes not related to surgery, patient died during G9626005004procedure without evidence of bladder injury) G9627001003Patient did not sustain bladder injury at the time of surgery nor discovered Pt no bl srg 30 day pst srg 00 9 C Z2 1 02016010120190101 C G9627002004subsequently up to 30n days post-surgery G9628001003Patient sustained bowel injury at the time of surgery or discovered Pt bwli srg 30 day pst srg 00 9 C Z2 1 02016010120190101 C G9628002004subsequently up to 30 days post-surgery G9629001003Documented medical reasons for not reporting bowel injury (e.g., gynecologic or Med rsn no rpt bowel inj 00 9 C Z2 1 02016010120170101 N G9629002004other pelvic malignancy documented, planned (e.g., not due to an unexpected G9629003004bowel injury) resection and/or re-anastomosis of bowel, or patient death from G9629004004non-medical causes not related to surgery, patient died during procedure G9629005004without evidence of bowel injury) G9630001003Patient did not sustain a bowel injury at the time of surgery nor discovered Pt no bwli srg 30 day srg 00 9 C Z2 1 02016010120190101 C G9630002004subsequently up to 30 days post-surgery G9631001003Patient sustained ureter injury at the time of surgery or discovered Pt ui srg 30 day pst srg 00 9 C Z2 1 02016010120190101 C G9631002004subsequently up to 30 days post-surgery G9632001003Documented medical reasons for not reporting ureter injury (e.g., gynecologic Med rsn for no rpt uret inj 00 9 C Z2 1 02016010120170101 N G9632002004or other pelvic malignancy documented, concurrent surgery involving bladder G9632003004pathology, injury that occurs during a urinary incontinence procedure, patient G9632004004death from non-medical causes not related to surgery, patient died during G9632005004procedure without evidence of ureter injury) G9633001003Patient did not sustain ureter injury at the time of surgery nor discovered Pt no ui srg 30 day pst srg 00 9 C Z2 1 02016010120190101 C G9633002004subsequently up to 30 days post-surgery G9634001003Health-related quality of life assessed with tool during at least two visits Qual life tool 2x same/impr 00 9 C Z2 1 02016010120160101 N G9634002004and quality of life score remained the same or improved G9635001003Health-related quality of life not assessed with tool for documented reason(s) No doc rsn do qual life assm00 9 C Z2 1 02016010120160101 N G9635002004(e.g., patient has a cognitive or neuropsychiatric impairment that impairs G9635003004his/her ability to complete the hrqol survey, patient has the inability to read G9635004004and/or write in order to complete the hrqol questionnaire) G9636001003Health-related quality of life not assessed with tool during at least two No life asst 2x same/decr 00 9 C Z2 1 02016010120160101 N G9636002004visits or quality of life score declined G9637001003Final reports with documentation of one or more dose reduction techniques Doc >1 dose reduc tech 00 9 C Z2 1 02016010120160101 N G9637002004(e.g., automated exposure control, adjustment of the ma and/or kv according to G9637003004patient size, use of iterative reconstruction technique) G9638001003Final reports without documentation of one or more dose reduction techniques No doc >1 dose reduc tech 00 9 C Z2 1 02016010120160101 N G9638002004(e.g., automated exposure control, adjustment of the ma and/or kv according to G9638003004patient size, use of iterative reconstruction technique) G9639001003Major amputation or open surgical bypass not required within 48 hours of the Amp no reqd in48h ieler proc00 9 C Z2 1 02016010120160101 N G9639002004index endovascular lower extremity revascularization procedure G9640001003Documentation of planned hybrid or staged procedure Doc plan hybrid/stage proc 00 9 C Z2 1 02016010120160101 N G9641001003Major amputation or open surgical bypass required within 48 hours of the index Amp reqd w/in 48h ieler proc00 9 C Z2 1 02016010120160101 N G9641002004endovascular lower extremity revascularization procedure G9642001003Current smokers (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) Current smoker 00 9 C Z2 1 02016010120170101 N G9643001003Elective surgery Elective surgery 00 9 C Z2 1 02016010120160101 N G9644001003Patients who abstained from smoking prior to anesthesia on the day of surgery No smok b/4 anes day of surg00 9 C Z2 1 02016010120160101 N G9644002004or procedure G9645001003Patients who did not abstain from smoking prior to anesthesia on the day of Had smoke b/4 anes day surg 00 9 C Z2 1 02016010120160101 N G9645002004surgery or procedure G9646001003Patients with 90 day mrs score of 0 to 2 Pt w/90d mrs 0-2 00 9 C Z2 1 02016010120160101 N G9647001003Patients in whom mrs score could not be obtained at 90 day follow-up No mrs score in 90d followup00 9 C Z2 1 02016010120160101 N G9648001003Patients with 90 day mrs score greater than 2 Pt w/90d mrs >2 00 9 C Z2 1 02016010120160101 N G9649001003Psoriasis assessment tool documented meeting any one of the specified Psor as doc spc bm 00 9 C Z2 1 02016010120190101 C G9649002004benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), G9649003004psoriasis area and severity index (pasi) and/or dermatology life quality index) G9649004004(dlqi)) G9650001003Documentation that the patient declined therapy change or has documented Doc pt no ther chg or contra00 9 C Z2 1 0201601012017010120161231N G9650002004contraindications (e.g., experienced adverse effects or lack of efficacy with G9650003004all other therapy options) in order to achieve better disease control as G9650004004measured by pga, bsa, pasi, or dlqi G9651001003Psoriasis assessment tool documented not meeting any one of the specified Psor as doc no spc bm 00 9 C Z2 1 02016010120190101 C G9651002004benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), G9651003004psoriasis area and severity index (pasi) and/or dermatology life quality index) G9651004004(dlqi)) or psoriasis assessment tool not documented G9652001003Patient has been treated with a systemic or biologic medication for psoriasis Pt tx sys bio med psori 6mth00 9 C Z2 1 0201601012017010120161231N G9652002004for at least six months G9653001003Patient has not been treated with a systemic or biologic medication for Pt no tx sys bio rx 6 mths 00 9 C Z2 1 0201601012017010120161231N G9653002004psoriasis for at least six months G9654001003Monitored anesthesia care (mac) Mon anesth care 00 9 C Z2 1 02016010120160101 N G9655001003A transfer of care protocol or handoff tool/checklist that includes the Toc tool incl key elem 00 9 C Z2 1 02016010120160101 N G9655002004required key handoff elements is used G9656001003Patient transferred directly from anesthetizing location to pacu or other Pt trans from anest to pacu 00 9 C Z2 1 02016010120180101 N G9656002004non-icu location G9657001003Transfer of care during an anesthetic or to the intensive care unit Toc dur aneth to icu 00 9 C Z2 1 0201601012017010120161231N G9658001003A transfer of care protocol or handoff tool/checklist that includes the Toc tool incl elem not used 00 9 C Z2 1 02016010120160101 N G9658002004required key handoff elements is not used G9659001003Patients greater than 85 years of age who did not have a history of colorectal >85y no hx colo ca/rsn scope00 9 C Z2 1 02016010120160101 N G9659002004cancer or valid medical reason for the colonoscopy, including: iron deficiency G9659003004anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional G9659004004enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary G9659005004non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative G9659006004colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits G9660001003Documentation of medical reason(s) for a colonoscopy performed on a patient Doc med rsn scope pt >85y 00 9 C Z2 1 02016010120160101 N G9660002004greater than 85 years of age (e.g., last colonoscopy incomplete, last G9660003004colonoscopy had inadequate prep, iron deficiency anemia, lower gastrointestinal G9660004004bleeding, crohn's disease (i.e., regional enteritis), familial history of G9660005004adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis G9660006004colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal G9660007004finding of gastrointestinal tract, or changes in bowel habits) G9661001003Patients greater than 85 years of age who received a routine colonoscopy for a >85y scope othr rsn 00 9 C Z2 1 02016010120160101 N G9661002004reason other than the following: an assessment of signs/symptoms of gi tract G9661003004illness, and/or the patient is considered high risk, and/or to follow-up on G9661004004previously diagnosed advance lesions G9662001003Previously diagnosed or have an active diagnosis of clinical ascvd Prior dx/active clin ascvd 00 9 C Z2 1 02016010120160101 N G9663001003Any fasting or direct ldl-c laboratory test result = 190 mg/dl Fast/dir ldl = 190 mg/dl 00 9 C Z2 1 02016010120160101 N G9664001003Patients who are currently statin therapy users or received an order Taking statin or rec'd order00 9 C Z2 1 02016010120160101 N G9664002004(prescription) for statin therapy G9665001003Patients who are not currently statin therapy users or did not receive an order No statin/no order statin 00 9 C Z2 1 02016010120160101 N G9665002004(prescription) for statin therapy G9666001003The highest fasting or direct ldl-c laboratory test result of 70-189 mg/dl in Fas/dir ldl 70-189mg/dl mst 00 9 C Z2 1 02016010120160101 N G9666002004the measurement period or two years prior to the beginning of the measurement G9666003004period G9667001003Documentation of medical reason(s) for not currently being a statin therapy Doc med rsn no stat tx/presc00 9 C Z2 1 0201601012017010120161231N G9667002004user or receive an order (prescription) for statin therapy (e.g., patient with G9667003004adverse effect, allergy or intolerance to statin medication therapy, patients G9667004004who have an active diagnosis of pregnancy or who are breastfeeding, patients G9667005004who are receiving palliative care, patients with active liver disease or G9667006004hepatic disease or insufficiency, patients with end stage renal disease (esrd), G9667007004and patients with diabetes who have a fasting or direct ldl-c laboratory test G9667008004result < 70 mg/dl and are not taking statin therapy) G9669001003I intend to report the multiple chronic conditions measures group Intend rpt mult chr msr grp 00 9 C Z2 1 0201601012017010120161231N G9670001003All quality actions for the applicable measures in the multiple chronic Qty act mcc mg perf 00 9 C Z2 1 0201601012017010120161231N G9670002004conditions measures group have been performed for this patient G9671001003I intend to report the diabetic retinopathy measures group Intend rpt dia retin msr grp00 9 C Z2 1 0201601012017010120161231N G9672001003All quality actions for the applicable measures in the diabetic retinopathy Qty act diab retin mg perf 00 9 C Z2 1 0201601012017010120161231N G9672002004measures group have been performed for this patient G9673001003I intend to report the cardiovascular prevention measures group Intend rpt card prev msr grp00 9 C Z2 1 0201601012017010120161231N G9674001003Patients with clinical ascvd diagnosis Pt w/clin ascvd dx 00 9 C Z2 1 02016010120160101 N G9675001003Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 Pt w/fast/dir lab ldl-c >19000 9 C Z2 1 02016010120160101 N G9675002004mg/dl G9676001003Patients aged 40 to 75 years at the beginning of the measurement period with 40-75y w/type 1/2 w/ldl-c rs00 9 C Z2 1 02016010120160101 N G9676002004type 1 or type 2 diabetes and with an ldl-c result of 70?189 mg/dl recorded as G9676003004the highest fasting or direct laboratory test result in the measurement year or G9676004004during the two years prior to the beginning of the measurement period G9677001003All quality actions for the applicable measures in the cardiovascular Qty act card prev mg perf 00 9 C Z2 1 0201601012017010120161231N G9677002004prevention measures group have been performed for this patient G9678001003Oncology care model (ocm) monthly enhanced oncology services (meos) payment for Oncology care model service 00 9 C Z2 1 02016040120160401 N G9678002004 ocm enhanced services. g9678 payments may only be made to ocm practitioners G9678003004for ocm beneficiaries for the furnishment of enhanced services as defined in G9678004004the ocm participation agreement G9679001003This code is for onsite acute care treatment of a nursing facility resident Acute care pneumonia 00 9 C Z2 1 02016100120161001 N G9679002004with pneumonia; may only be billed once per day per beneficiary G9680001003This code is for onsite acute care treatment of a nursing facility resident Acute care congestive heart 00 9 C Z2 1 02016100120161001 N G9680002004with chf; may only be billed once per day per beneficiary G9681001003This code is for onsite acute care treatment of a resident with copd or asthma; Acute care chronic obstruct 00 9 C Z2 1 02016100120161001 N G9681002004may only be billed once per day per beneficiary G9682001003This code is for the onsite acute care treatment a nursing facility resident Acute care skin infection 00 9 C Z2 1 02016100120161001 N G9682002004with a skin infection; may only be billed once per day per beneficiary G9683001003Facility service(s) for the onsite acute care treatment of a nursing facility Acute fluid/electro disorder00 9 C Z2 1 02016100120190101 C G9683002004resident with fluid or electrolyte disorder. (may only be billed once per day G9683003004per beneficiary). this service is for a demonstration project G9684001003This code is for the onsite acute care treatment of a nursing facility resident Acute care urinary tract inf00 9 C Z2 1 02016100120161001 N G9684002004for a uti; may only be billed once per day per beneficiary G9685001003Physician service or other qualified health care professional for the Acute nursing facility care 00 9 C Z2 1 02016100120190101 C G9685002004evaluation and management of a beneficiary's acute change in condition in a G9685003004nursing facility. this service is for a demonstration project G9686001003Onsite nursing facility conference, that is separate and distinct from an Nursing facility conference 00 9 C Z2 1 0201610012019010120181231D G9686002004evaluation and management visit, including qualified practitioner and at least G9686003004one member of the nursing facility interdisciplinary care team G9687001003Hospice services provided to patient any time during the measurement period Hospice anytime msmt per 00 9 C Z2 1 02017010120170101 N G9688001003Patients using hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9689001003Patient admitted for performance of elective carotid intervention Inpt elect carotid intervent00 9 C Z2 1 02017010120170101 N G9690001003Patient receiving hospice services any time during the measurement period Pt in hos 00 9 C Z2 1 02017010120190101 S G9691001003Patient had hospice services any time during the measurement period Pt hosp dur msmt period 00 9 C Z2 1 02017010120170101 N G9692001003Hospice services received by patient any time during the measurement period Hosp recd by pt dur msmt per00 9 C Z2 1 02017010120170101 N G9693001003Patient use of hospice services any time during the measurement period Pt use hosp during msmt per 00 9 C Z2 1 02017010120170101 N G9694001003Hospice services utilized by patient any time during the measurement period Hosp srv used pt in msmt per00 9 C Z2 1 02017010120170101 N G9695001003Long-acting inhaled bronchodilator prescribed Long act inhal bronchdil pre00 9 C Z2 1 02017010120170101 N G9696001003Documentation of medical reason(s) for not prescribing a long-acting inhaled Med rsn no presc bronchdil 00 9 C Z2 1 02017010120170101 N G9696002004bronchodilator G9697001003Documentation of patient reason(s) for not prescribing a long-acting inhaled Pt rsn no presc bronchdil 00 9 C Z2 1 02017010120170101 N G9697002004bronchodilator G9698001003Documentation of system reason(s) for not prescribing a long-acting inhaled Sys rsn no presc bronchdil 00 9 C Z2 1 02017010120170101 N G9698002004bronchodilator G9699001003Long-acting inhaled bronchodilator not prescribed, reason not otherwise Long inhal bronchdil no pres00 9 C Z2 1 02017010120170101 N G9699002004specified G9700001003Patients who use hospice services any time during the measurement period Pt is w/hosp during msmt per00 9 C Z2 1 02017010120170101 N G9701001003Children who are taking antibiotics in the 30 days prior to the date of the Child anbx 30 prior dx estab00 9 C Z2 1 02017010120170101 N G9701002004encounter during which the diagnosis was established G9702001003Patients who use hospice services any time during the measurement period Pt use hosp during msmt per 00 9 C Z2 1 02017010120170101 N G9703001003Children who are taking antibiotics in the 30 days prior to the diagnosis of Child anbx 30 prior dx phary00 9 C Z2 1 02017010120170101 N G9703002004pharyngitis G9704001003Ajcc breast cancer stage i: t1 mic or t1a documented Ajcc br ca stg i: t1 mic/t1a00 9 C Z2 1 02017010120170101 N G9705001003Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest Ajcc br ca stg ib 00 9 C Z2 1 02017010120170101 N G9705002004dimension) documented G9706001003Low (or very low) risk of recurrence, prostate cancer Low recur prost ca 00 9 C Z2 1 02017010120170101 N G9707001003Patient received hospice services any time during the measurement period Pt had hosp dur msmt per 00 9 C Z2 1 02017010120170101 N G9708001003Women who had a bilateral mastectomy or who have a history of a bilateral Bilat mast/hx bi /unilat mas00 9 C Z2 1 02017010120170101 N G9708002004mastectomy or for whom there is evidence of a right and a left unilateral G9708003004mastectomy G9709001003Hospice services used by patient any time during the measurement period Hosp srv used pt in msmt per00 9 C Z2 1 02017010120170101 N G9710001003Patient was provided hospice services any time during the measurement period Pt prov hosp srv msmt per 00 9 C Z2 1 02017010120170101 N G9711001003Patients with a diagnosis or past history of total colectomy or colorectal Pt hx tot col or colon ca 00 9 C Z2 1 02017010120170101 N G9711002004cancer G9712001003Documentation of medical reason(s) for prescribing or dispensing antibiotic Doc med rsn presc anbx 00 9 C Z2 1 02017010120170101 N G9712002004(e.g., intestinal infection, pertussis, bacterial infection, lyme disease, G9712003004otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic G9712004004sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, G9712005004cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin G9712006004staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, G9712007004chlamydia, inflammatory diseases [female reproductive organs]), infections of G9712008004the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, G9712009004disorders of the immune system, malignancy neoplasms, chronic bronchitis, G9712010004emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway G9712011004obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease G9712012004due to external agents, other diseases of the respiratory system, and G9712013004tuberculosis G9713001003Patients who use hospice services any time during the measurement period Pt use hosp during msmt per 00 9 C Z2 1 02017010120170101 N G9714001003Patient is using hospice services any time during the measurement period Pt is w/hosp during msmt per00 9 C Z2 1 02017010120170101 N G9715001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9716001003Bmi is documented as being outside of normal limits, follow-up plan is not Bmi doc onl fup not cmpltd 00 9 C Z2 1 02017010120180101 N G9716002004completed for documented reason G9717001003Documentation stating the patient has an active diagnosis of depression or has Doc pt dx dep/bp f/u nt req 00 9 C Z2 1 02017010120180101 N G9717002004a diagnosed bipolar disorder, therefore screening or follow-up not required G9718001003Hospice services for patient provided any time during the measurement period Hospice anytime msmt per 00 9 C Z2 1 02017010120170101 N G9719001003Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair Pt not ambul/immob/wc 00 9 C Z2 1 02017010120170101 N G9719002004bound, dependent on helper pushing wheelchair, independent in wheelchair or G9719003004minimal help in wheelchair G9720001003Hospice services for patient occurred any time during the measurement period Hospice anytime msmt per 00 9 C Z2 1 02017010120170101 N G9721001003Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair Pt not ambul/immob/wc 00 9 C Z2 1 02017010120170101 N G9721002004bound, dependent on helper pushing wheelchair, independent in wheelchair or G9721003004minimal help in wheelchair G9722001003Documented history of renal failure or baseline serum creatinine = 4.0 mg/dl; Doc hx renal fail or cr+ >4 00 9 C Z2 1 02017010120170101 N G9722002004renal transplant recipients are not considered to have preoperative renal G9722003004failure, unless, since transplantation the cr has been or is 4.0 or higher G9723001003Hospice services for patient received any time during the measurement period Hosp recd by pt dur msmt per00 9 C Z2 1 02017010120170101 N G9724001003Patients who had documentation of use of anticoagulant medications overlapping Pt w/doc use anticoag mst yr00 9 C Z2 1 02017010120170101 N G9724002004the measurement year G9725001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9726001003Patient refused to participate Refused to participate 00 9 C Z2 1 02017010120170101 N G9727001003Patient unable to complete the knee fs prom at admission and discharge due to Pt unable cmplt knee fs prom00 9 C Z2 1 02017010120190101 C G9727002004blindness, illiteracy, severe mental incapacity or language incompatibility and G9727003004an adequate proxy is not available G9728001003Patient refused to participate Refused to participate 00 9 C Z2 1 02017010120170101 N G9729001003Patient unable to complete the hip fs prom at admission and discharge due to Pt unbl cmplt hip fs prom 00 9 C Z2 1 02017010120190101 C G9729002004blindness, illiteracy, severe mental incapacity or language incompatibility and G9729003004an adequate proxy is not available G9730001003Patient refused to participate Refused to participate 00 9 C Z2 1 02017010120170101 N G9731001003Patient unable to complete the foot/ankle fs prom at admission and discharge Pt unbl cmplt ft/ank fs prom00 9 C Z2 1 02017010120190101 C G9731002004due to blindness, illiteracy, severe mental incapacity or language G9731003004incompatibility and an adequate proxy is not available G9732001003Patient refused to participate Refused to participate 00 9 C Z2 1 02017010120170101 N G9733001003Patient unable to complete the low back fs prom at admission and discharge due Pt unbl cmplt lb fs prom 00 9 C Z2 1 02017010120190101 C G9733002004to blindness, illiteracy, severe mental incapacity or language incompatibility G9733003004and an adequate proxy is not available G9734001003Patient refused to participate Refused to participate 00 9 C Z2 1 02017010120170101 N G9735001003Patient unable to complete the shoulder fs prom at admission and discharge due Pt unbl cmplt shld fs prom 00 9 C Z2 1 02017010120190101 C G9735002004to blindness, illiteracy, severe mental incapacity or language incompatibility G9735003004and an adequate proxy is not available G9736001003Patient refused to participate Refused to participate 00 9 C Z2 1 02017010120170101 N G9737001003Patient unable to complete the elbow/wrist/hand fs prom at admission and Pt unbl cmplt ewh fs prom 00 9 C Z2 1 02017010120190101 C G9737002004discharge due to blindness, illiteracy, severe mental incapacity or language G9737003004incompatibility and an adequate proxy is not available G9738001003Patient refused to participate Refused to participate 00 9 C Z2 1 02017010120170101 N G9739001003Patient unable to complete the general orthopedic fs prom at admission and Pt unbl cmplt go fs prom 00 9 C Z2 1 02017010120190101 C G9739002004discharge due to blindness, illiteracy, severe mental incapacity or language G9739003004incompatibility and an adequate proxy is not available G9740001003Hospice services given to patient any time during the measurement period Hosp srv to pt dur msmt per 00 9 C Z2 1 02017010120170101 N G9741001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9742001003Psychiatric symptoms assessed Psych sympt assessed 00 9 C Z2 1 02017010120170101 N G9743001003Psychiatric symptoms not assessed, reason not otherwise specified Psych symp not assessed, rns00 9 C Z2 1 02017010120170101 N G9744001003Patient not eligible due to active diagnosis of hypertension Pt not eli d/t act dig htn 00 9 C Z2 1 02017010120180101 N G9745001003Documented reason for not screening or recommending a follow-up for high blood Doc rsn no hbp scrn or f/u 00 9 C Z2 1 02017010120180101 N G9745002004pressure G9746001003Patient has mitral stenosis or prosthetic heart valves or patient has transient Mit sten, valve or trans af 00 9 C Z2 1 02017010120170101 N G9746002004or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac G9746003004surgery) G9747001003Patient is undergoing palliative dialysis with a catheter Pall dialysis with catheter 00 9 C Z2 1 02017010120170101 N G9748001003Patient approved by a qualified transplant program and scheduled to receive a App transpl lvg kidney donor00 9 C Z2 1 02017010120170101 N G9748002004living donor kidney transplant G9749001003Patient is undergoing palliative dialysis with a catheter Pall dialysis with catheter 00 9 C Z2 1 02017010120170101 N G9750001003Patient approved by a qualified transplant program and scheduled to receive a App transpl lvg kidney donor00 9 C Z2 1 02017010120170101 N G9750002004living donor kidney transplant G9751001003Patient died at any time during the 24-month measurement period Pt died w/in 24 mos rpt time00 9 C Z2 1 02017010120170101 N G9752001003Emergency surgery Urgent surgery 00 9 C Z2 1 02017010120170101 N G9753001003Documentation of medical reason for not conducting a search for dicom format Doc no dicom, ct other fac 00 9 C Z2 1 02017010120170101 N G9753002004images for prior patient ct imaging studies completed at non-affiliated G9753003004external healthcare facilities or entities within the past 12 months that are G9753004004available through a secure, authorized, media-free, shared archive (e.g., G9753005004trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of G9753006004the essence) G9754001003A finding of an incidental pulmonary nodule Incid pulm nodule 00 9 C Z2 1 02017010120170101 N G9755001003Documentation of medical reason(s) for not including a recommended interval and Doc med rsn no fllw up 00 9 C Z2 1 02017010120190101 C G9755002004modality for follow-up or for no follow-up, and source of recommendations G9755003004(e.g., patients with unexplained fever, immunocompromised patients who are at G9755004004risk for infection) G9756001003Surgical procedures that included the use of silicone oil Surg proc w/silicone oil 00 9 C Z2 1 02017010120170101 N G9757001003Surgical procedures that included the use of silicone oil Surg proc w/silicone oil 00 9 C Z2 1 02017010120170101 N G9758001003Patient in hospice at any time during the measurement period Pt in hos 00 9 C Z2 1 02017010120180101 N G9759001003History of preoperative posterior capsule rupture Hx preop post cap rup 00 9 C Z2 1 02017010120170101 N G9760001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9761001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9762001003Patient had at least two hpv vaccines (with at least 146 days between the two) Pt had >= 2-3 hpv vaccines 00 9 C Z2 1 02017010120180101 N G9762002004or three hpv vaccines on or between the patient's 9th and 13th birthdays G9763001003Patient did not have at least two hpv vaccines (with at least 146 days between Pt not have 2-3 hpv vaccines00 9 C Z2 1 02017010120180101 N G9763002004the two) or three hpv vaccines on or between the patient's 9th and 13th G9763003004birthdays G9764001003Patient has been treated with a systemic medication for psoriasis vulgaris Pt treatd w/oral syst or bio00 9 C Z2 1 02017010120190101 C G9765001003Documentation that the patient declined change in medication or alternative Doc pat declined therapy 00 9 C Z2 1 02017010120190101 C G9765002004therapies were unavailable, has documented contraindications, or has not been G9765003004treated with a systemic medication for at least six consecutive months (e.g., G9765004004experienced adverse effects or lack of efficacy with all other therapy options) G9765005004in order to achieve better disease control as measured by pga, bsa, pasi, or G9765006004dlqi G9766001003Patients who are transferred from one institution to another with a known Cva stroke dx tx transf fac 00 9 C Z2 1 02017010120170101 N G9766002004diagnosis of cva for endovascular stroke treatment G9767001003Hospitalized patients with newly diagnosed cva considered for endovascular Hosp new dx cva consid evst 00 9 C Z2 1 02017010120170101 N G9767002004stroke treatment G9768001003Patients who utilize hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9769001003Patient had a bone mineral density test in the past two years or received Bn den 2yr/got ost med/ther 00 9 C Z2 1 02017010120170101 N G9769002004osteoporosis medication or therapy in the past 12 months G9770001003Peripheral nerve block (pnb) Perip nerve block 00 9 C Z2 1 02017010120170101 N G9771001003At least 1 body temperature measurement equal to or greater than 35.5 degrees Anes end, 1 temp >35.5(95.9)00 9 C Z2 1 02017010120170101 N G9771002004celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately G9771003004before or the 15 minutes immediately after anesthesia end time G9772001003Documentation of one of the following medical reason(s) for not achieving at Doc med rsn no temp >= 35.5 00 9 C Z2 1 02017010120190101 C G9772002004least 1 body temperature measurement equal to or greater than 35.5 degrees G9772003004celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before G9772004004or the 15 minutes immediately after anesthesia end time (e.g., emergency cases, G9772005004intentional hypothermia, etc.) G9773001003At least 1 body temperature measurement equal to or greater than 35.5 degrees 1 bod temp >=35.5 00 9 C Z2 1 02017010120190101 C G9773002004celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes G9773003004immediately before or the 15 minutes immediately after anesthesia end time, G9773004004reason not given G9774001003Patients who have had a hysterectomy Pt had hyst 00 9 C Z2 1 02017010120170101 N G9775001003Patient received at least 2 prophylactic pharmacologic anti-emetic agents of Recd 2 anti-emet pre/intraop00 9 C Z2 1 02017010120170101 N G9775002004different classes preoperatively and/or intraoperatively G9776001003Documentation of medical reason for not receiving at least 2 prophylactic Doc med rsn no proph antiem 00 9 C Z2 1 02017010120170101 N G9776002004pharmacologic anti-emetic agents of different classes preoperatively and/or G9776003004intraoperatively (e.g., intolerance or other medical reason) G9777001003Patient did not receive at least 2 prophylactic pharmacologic anti-emetic Pt no antiemet pre/intraop 00 9 C Z2 1 02017010120170101 N G9777002004agents of different classes preoperatively and/or intraoperatively G9778001003Patients who have a diagnosis of pregnancy Pts dx w/pregn 00 9 C Z2 1 02017010120170101 N G9779001003Patients who are breastfeeding Pts breastfeeding 00 9 C Z2 1 02017010120170101 N G9780001003Patients who have a diagnosis of rhabdomyolysis Pts dx w/rhabdomyolysis 00 9 C Z2 1 02017010120170101 N G9781001003Documentation of medical reason(s) for not currently being a statin therapy Doc rsn no statin 00 9 C Z2 1 02017010120170101 N G9781002004user or receive an order (prescription) for statin therapy (e.g., patient with G9781003004adverse effect, allergy or intolerance to statin medication therapy, patients G9781004004who are receiving palliative care, patients with active liver disease or G9781005004hepatic disease or insufficiency, and patients with end stage renal disease G9781006004(esrd)) G9782001003History of or active diagnosis of familial or pure hypercholesterolemia Hx dx fam/pure hypercholes 00 9 C Z2 1 02017010120170101 N G9783001003Documentation of patients with diabetes who have a most recent fasting or Doc dx dm, fast <70, no stat00 9 C Z2 1 02017010120170101 N G9783002004direct ldl- c laboratory test result < 70 mg/dl and are not taking statin G9783003004therapy G9784001003Pathologists/dermatopathologists providing a second opinion on a biopsy Path/derm prov 2nd biop opin00 9 C Z2 1 02017010120180101 N G9785001003Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell Pathology report sent 00 9 C Z2 1 02017010120180101 N G9785002004carcinoma (to include in situ disease) sent from the G9785003004pathologist/dermatopathologist to the biopsying clinician for review within 7 G9785004004days from the time when the tissue specimen was received by the pathologist G9786001003Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell Pathology report not sent 00 9 C Z2 1 02017010120180101 N G9786002004carcinoma (to include in situ disease) was not sent from the G9786003004pathologist/dermatopathologist to the biopsying clinician for review within 7 G9786004004days from the time when the tissue specimen was received by the pathologist G9787001003Patient alive as of the last day of the measurement year Pt alive 00 9 C Z2 1 02017010120190101 S G9788001003Most recent bp is less than or equal to 140/90 mm hg Most rct bp /= 140/90 00 9 C Z2 1 02017010120170101 N G9791001003Most recent tobacco status is tobacco free Most rct tob stat free 00 9 C Z2 1 02017010120170101 N G9792001003Most recent tobacco status is not tobacco free Most rct tob stat not free 00 9 C Z2 1 02017010120170101 N G9793001003Patient is currently on a daily aspirin or other antiplatelet Pt on daily asa/antiplat 00 9 C Z2 1 02017010120170101 N G9794001003Documentation of medical reason(s) for not on a daily aspirin or other Doc med rsn no daily aspirin00 9 C Z2 1 02017010120180101 N G9794002004antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, G9794003004idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of G9794004004active anticoagulant use during the measurement period) G9795001003Patient is not currently on a daily aspirin or other antiplatelet Pt no daily asa/antiplat 00 9 C Z2 1 02017010120170101 N G9796001003Patient is currently on a statin therapy Pt not currently on statin 00 9 C Z2 1 02017010120170101 N G9797001003Patient is not on a statin therapy Pt currently on statin 00 9 C Z2 1 02017010120170101 N G9798001003Discharge(s) for ami between july 1 of the year prior measurement year to june D/c ami btw 7/1-6/30 mst per00 9 C Z2 1 02017010120170101 N G979800200430 of the measurement period G9799001003Patients with a medication dispensing event indicator of a history of asthma Med disp evt indic hx asth 00 9 C Z2 1 02017010120170101 N G9799002004any time during the patient's history through the end of the measure period G9800001003Patients who are identified as having an intolerance or allergy to beta-blocker Pt id intol/alleg beta-block00 9 C Z2 1 02017010120170101 N G9800002004therapy G9801001003Hospitalizations in which the patient was transferred directly to a non-acute Nonacut transf from inpt 00 9 C Z2 1 02017010120170101 N G9801002004care facility for any diagnosis G9802001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9803001003Patient prescribed at least a 135 day treatment within the 180-day measurement Pt presc 135 day trmt 00 9 C Z2 1 02017010120190101 C G9803002004interval with beta-blockers post-discharge for ami G9804001003Patient was not prescribed at least a 135 day treatment within the 180-day Pt not presc 135 day trmt 00 9 C Z2 1 02017010120190101 C G9804002004measurement interval with beta-blockers post-discharge for ami G9805001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9806001003Patients who received cervical cytology or an hpv test Pt recd cerv cyto/hpv 00 9 C Z2 1 02017010120170101 N G9807001003Patients who did not receive cervical cytology or an hpv test Pt no recd cerv cyto/hpv 00 9 C Z2 1 02017010120170101 N G9808001003Any patients who had no asthma controller medications dispensed during the Pt no asthm cont med mst per00 9 C Z2 1 02017010120170101 N G9808002004measurement year G9809001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9810001003Patient achieved a pdc of at least 75% for their asthma controller medication Pdc 75% w/asth cont med 00 9 C Z2 1 02017010120170101 N G9811001003Patient did not achieve a pdc of at least 75% for their asthma controller No pdc 75% w/asth cont med 00 9 C Z2 1 02017010120170101 N G9811002004medication G9812001003Patient died including all deaths occurring during the hospitalization in which Pt died during inpt/30d aft 00 9 C Z2 1 02017010120170101 N G9812002004the operation was performed, even if after 30 days, and those deaths occurring G9812003004after discharge from the hospital, but within 30 days of the procedure G9813001003Patient did not die within 30 days of the procedure or during the index Pt not died w/in 30d of proc00 9 C Z2 1 02017010120170101 N G9813002004hospitalization G9814001003Death occurring during the index acute care hospitalization Death during index hosp 00 9 C Z2 1 02017010120180101 N G9815001003Death did not occur during the index acute care hospitalization Death not during index hosp 00 9 C Z2 1 02017010120180101 N G9816001003Death occurring after discharge from the hospital but within 30 days post Death <30 day post discharge00 9 C Z2 1 02017010120180101 N G9816002004procedure G9817001003Death did not occur after discharge from the hospital within 30 days post No death 30-days post-disch 00 9 C Z2 1 02017010120180101 N G9817002004procedure G9818001003Documentation of sexual activity Doc sex activity 00 9 C Z2 1 02017010120170101 N G9819001003Patients who use hospice services any time during the measurement period Pt w/hosp anytime msmt per 00 9 C Z2 1 02017010120170101 N G9820001003Documentation of a chlamydia screening test with proper follow-up Doc chlam scr test w/follow 00 9 C Z2 1 02017010120170101 N G9821001003No documentation of a chlamydia screening test with proper follow-up No doc chlam scr ts w/follow00 9 C Z2 1 02017010120170101 N G9822001003Women who had an endometrial ablation procedure during the year prior to the Endo abl proc yr prev ind dt00 9 C Z2 1 02017010120170101 N G9822002004index date (exclusive of the index date) G9823001003Endometrial sampling or hysteroscopy with biopsy and results documented Endo smpl/hyst bx res doc 00 9 C Z2 1 02017010120170101 N G9824001003Endometrial sampling or hysteroscopy with biopsy and results not documented Endo smpl/hyst bx res no doc00 9 C Z2 1 02017010120170101 N G9825001003Her-2/neu negative or undocumented/unknown Her-2 neg,undoc/unkn 00 9 C Z2 1 02017010120170101 N G9826001003Patient transferred to practice after initiation of chemotherapy Transf pract aft init chemo 00 9 C Z2 1 02017010120170101 N G9827001003Her2-targeted therapies not administered during the initial course of treatment Her-2 targ ther no init tx 00 9 C Z2 1 02017010120170101 N G9828001003Her2-targeted therapies administered during the initial course of treatment Her-2 targ ther dur init tx 00 9 C Z2 1 02017010120170101 N G9829001003Breast adjuvant chemotherapy administered Breast adj chemo admin 00 9 C Z2 1 02017010120170101 N G9830001003Her-2/neu positive Her-2 pos 00 9 C Z2 1 02017010120170101 N G9831001003Ajcc stage at breast cancer diagnosis = ii or iii Ajcc stg brt ca dx ii or iii00 9 C Z2 1 02017010120170101 N G9832001003Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast Brt ca dx i, no t1/t1a/t1b 00 9 C Z2 1 02017010120170101 N G9832002004cancer diagnosis does not equal = t1, t1a, t1b G9833001003Patient transfer to practice after initiation of chemotherapy Transf pract aft init chemo 00 9 C Z2 1 02017010120170101 N G9834001003Patient has metastatic disease at diagnosis Pt met dis at dx 00 9 C Z2 1 02017010120170101 N G9835001003Trastuzumab administered within 12 months of diagnosis Trastuz given w/in 12 mos dx00 9 C Z2 1 02017010120170101 N G9836001003Reason for not administering trastuzumab documented (e.g. patient declined, Rsn no trast given doc 00 9 C Z2 1 02017010120170101 N G9836002004patient died, patient transferred, contraindication or other clinical G9836003004exclusion, neoadjuvant chemotherapy or radiation not complete) G9837001003Trastuzumab not administered within 12 months of diagnosis Trastuz not in 12 mos dx 00 9 C Z2 1 02017010120170101 N G9838001003Patient has metastatic disease at diagnosis Pt met dis at dx 00 9 C Z2 1 02017010120170101 N G9839001003Anti-egfr monoclonal antibody therapy Anti-egfr mon anti ther 00 9 C Z2 1 02017010120170101 N G9840001003Ras (kras and nras) gene mutation testing performed before initiation of Gene testing performed 00 9 C Z2 1 02017010120180101 N G9840002004anti-egfr moab G9841001003Ras (kras and nras) gene mutation testing not performed before initiation of Gene testing not performed 00 9 C Z2 1 02017010120180101 N G9841002004anti-egfr moab G9842001003Patient has metastatic disease at diagnosis Pt met dis at dx 00 9 C Z2 1 02017010120170101 N G9843001003Ras (kras or nras) gene mutation Kras or nras gene mutation 00 9 C Z2 1 02017010120180101 N G9844001003Patient did not receive anti-egfr monoclonal antibody therapy Pt no recd anti-egfr ther 00 9 C Z2 1 02017010120170101 N G9845001003Patient received anti-egfr monoclonal antibody therapy Pt recd anti-egfr ther 00 9 C Z2 1 02017010120170101 N G9846001003Patients who died from cancer Pt died from cancer 00 9 C Z2 1 02017010120170101 N G9847001003Patient received chemotherapy in the last 14 days of life Pt recd chemo last 14d life 00 9 C Z2 1 02017010120170101 N G9848001003Patient did not receive chemotherapy in the last 14 days of life Pt no chemo last 14d life 00 9 C Z2 1 02017010120170101 N G9849001003Patients who died from cancer Pt died from cancer 00 9 C Z2 1 02017010120170101 N G9850001003Patient had more than one emergency department visit in the last 30 days of life1/more ed last 30d life 00 9 C Z2 1 02017010120170101 N G9851001003Patient had one or less emergency department visits in the last 30 days of life 1/no ed visit last 30d life 00 9 C Z2 1 02017010120170101 N G9852001003Patients who died from cancer Pt died from cancer 00 9 C Z2 1 02017010120170101 N G9853001003Patient admitted to the icu in the last 30 days of life Icu stay last 30d life 00 9 C Z2 1 02017010120170101 N G9854001003Patient was not admitted to the icu in the last 30 days of life No icu stay last 30d life 00 9 C Z2 1 02017010120170101 N G9855001003Patients who died from cancer Pt died from cancer 00 9 C Z2 1 02017010120170101 N G9856001003Patient was not admitted to hospice Pt no hospice 00 9 C Z2 1 02017010120170101 N G9857001003Patient admitted to hospice Pt admit hospice 00 9 C Z2 1 02017010120170101 N G9858001003Patient enrolled in hospice Pt enroll hospice 00 9 C Z2 1 02017010120170101 N G9859001003Patients who died from cancer Pt died from cancer 00 9 C Z2 1 02017010120170101 N G9860001003Patient spent less than three days in hospice care Pt less 3d hospice 00 9 C Z2 1 02017010120170101 N G9861001003Patient spent greater than or equal to three days in hospice care Pt more than 3d hospice 00 9 C Z2 1 02017010120170101 N G9862001003Documentation of medical reason(s) for not recommending at least a 10 year Doc rsn no 10 yr follow 00 9 C Z2 1 02017010120170101 N G9862002004follow-up interval (e.g., inadequate prep, familial or personal history of G9862003004colonic polyps, patient had no adenoma and age is = 66 years old, or life G9862004004expectancy < 10 years old, other medical reasons) G9868001003Receipt and analysis of remote, asynchronous images for dermatologic and/or Next gen aco model <10min 13 A C M5D 1 02018010120180101 N G9868002004ophthalmologic evaluation, for use under the next generation aco model, less G9868003004than 10 minutes G9869001003Receipt and analysis of remote, asynchronous images for dermatologic and/or Next gen aco model 10-20min 13 A C M5D 1 02018010120180101 N G9869002004ophthalmologic evaluation, for use under the next generation aco model, 10-20 G9869003004minutes G9870001003Receipt and analysis of remote, asynchronous images for dermatologic and/or Next gen aco model >20min 13 A C M5D 1 02018010120180101 N G9870002004ophthalmologic evaluation, for use under the next generation aco model, 20 or G9870003004more minutes G9873001003First medicare diabetes prevention program (mdpp) core session was attended by 1 em core session 00 9 C Y1 1 02018040120180401 A G9873002004an mdpp beneficiary under the mdpp expanded model (em). a core session is an G9873003004mdpp service that: (1) is furnished by an mdpp supplier during months 1 G9873004004through 6 of the mdpp services period; (2) is approximately 1 hour in length; G9873005004and (3) adheres to a cdc-approved dpp curriculum for core sessions G9874001003Four total medicare diabetes prevention program (mdpp) core sessions were 4 em core sessions 00 9 C Y1 1 02018040120180401 A G9874002004attended by an mdpp beneficiary under the mdpp expanded model (em). a core G9874003004session is an mdpp service that: (1) is furnished by an mdpp supplier during G9874004004months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in G9874005004length; and (3) adheres to a cdc-approved dpp curriculum for core sessions G9875001003Nine total medicare diabetes prevention program (mdpp) core sessions were 9 em core sessions 00 9 C Y1 1 02018040120180401 A G9875002004attended by an mdpp beneficiary under the mdpp expanded model (em). a core G9875003004session is an mdpp service that: (1) is furnished by an mdpp supplier during G9875004004months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in G9875005004length; and (3) adheres to a cdc-approved dpp curriculum for core sessions G9876001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) 2 em core ms mo 7-9 no wl 00 9 C Y1 1 02018040120180401 A G9876002004were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded G9876003004model (em). a core maintenance session is an mdpp service that: (1) is G9876004004furnished by an mdpp supplier during months 7 through 12 of the mdpp services G9876005004period; (2) is approximately 1 hour in length; and (3) adheres to a G9876006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not G9876007004achieve at least 5% weight loss (wl) from his/her baseline weight, as measured G9876008004by at least one in-person weight measurement at a core maintenance session in G9876009004months 7-9 G9877001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) 2 em core ms mo 10-12 no wl 00 9 C Y1 1 02018040120180401 A G9877002004were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp G9877003004expanded model (em). a core maintenance session is an mdpp service that: (1) G9877004004is furnished by an mdpp supplier during months 7 through 12 of the mdpp G9877005004services period; (2) is approximately 1 hour in length; and (3) adheres to a G9877006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not G9877007004achieve at least 5% weight loss (wl) from his/her baseline weight, as measured G9877008004by at least one in-person weight measurement at a core maintenance session in G9877009004months 10-12 G9878001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) 2 em core ms mo 7-9 wl 00 9 C Y1 1 02018040120180401 A G9878002004were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded G9878003004model (em). a core maintenance session is an mdpp service that: (1) is G9878004004furnished by an mdpp supplier during months 7 through 12 of the mdpp services G9878005004period; (2) is approximately 1 hour in length; and (3) adheres to a G9878006004cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved G9878007004at least 5% weight loss (wl) from his/her baseline weight, as measured by at G9878008004least one in-person weight measurement at a core maintenance session in months G98780090047-9 G9879001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) 2 em core ms mo 10-12 wl 00 9 C Y1 1 02018040120180401 A G9879002004were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp G9879003004expanded model (em). a core maintenance session is an mdpp service that: (1) G9879004004is furnished by an mdpp supplier during months 7 through 12 of the mdpp G9879005004services period; (2) is approximately 1 hour in length; and (3) adheres to a G9879006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved G9879007004at least 5% weight loss (wl) from his/her baseline weight, as measured by at G9879008004least one in-person weight measurement at a core maintenance session in months G987900900410-12 G9880001003The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her Em 5 percent wl 00 9 C Y1 1 02018040120180401 A G9880002004baseline weight in months 1-12 of the mdpp services period under the mdpp G9880003004expanded model (em). this is a one-time payment available when a beneficiary G9880004004first achieves at least 5% weight loss from baseline as measured by an G9880005004in-person weight measurement at a core session or core maintenance session G9881001003The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her Em 9 percent wl 00 9 C Y1 1 02018040120180401 A G9881002004baseline weight in months 1-24 under the mdpp expanded model (em). this is a G9881003004one-time payment available when a beneficiary first achieves at least 9% weight G9881004004loss from baseline as measured by an in-person weight measurement at a core G9881005004session, core maintenance session, or ongoing maintenance session G9882001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions 2 em ongoing ms mo 13-15 wl 00 9 C Y1 1 02018040120180401 A G9882002004(ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp G9882003004expanded model (em). an ongoing maintenance session is an mdpp service that: G9882004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp G9882005004services period; (2) is approximately 1 hour in length; and (3) adheres to a G9882006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary G9882007004maintained at least 5% weight loss (wl) from his/her baseline weight, as G9882008004measured by at least one in-person weight measurement at an ongoing maintenance G9882009004session in months 13-15 G9883001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions 2 em ongoing ms mo 16-18 wl 00 9 C Y1 1 02018040120180401 A G9883002004(ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp G9883003004expanded model (em). an ongoing maintenance session is an mdpp service that: G9883004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp G9883005004services period; (2) is approximately 1 hour in length; and (3) adheres to a G9883006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary G9883007004maintained at least 5% weight loss (wl) from his/her baseline weight, as G9883008004measured by at least one in-person weight measurement at an ongoing maintenance G9883009004session in months 16-18 G9884001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions 2 em ongoing ms mo 19-21 wl 00 9 C Y1 1 02018040120180401 A G9884002004(ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp G9884003004expanded model (em). an ongoing maintenance session is an mdpp service that: G9884004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp G9884005004services period; (2) is approximately 1 hour in length; and (3) adheres to a G9884006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary G9884007004maintained at least 5% weight loss (wl) from his/her baseline weight, as G9884008004measured by at least one in-person weight measurement at an ongoing maintenance G9884009004session in months 19-21 G9885001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions 2 em ongoing ms mo 22-24 wl 00 9 C Y1 1 02018040120180401 A G9885002004(ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp G9885003004expanded model (em). an ongoing maintenance session is an mdpp service that: G9885004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp G9885005004services period; (2) is approximately 1 hour in length; and (3) adheres to a G9885006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary G9885007004maintained at least 5% weight loss (wl) from his/her baseline weight, as G9885008004measured by at least one in-person weight measurement at an ongoing maintenance G9885009004session in months 22-24 G9890001003Bridge payment: a one-time payment for the first medicare diabetes prevention Em bridge payment 00 9 C Y1 1 02018040120180401 A G9890002004program (mdpp) core session, core maintenance session, or ongoing maintenance G9890003004session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 G9890004004of the mdpp expanded model (em) who has previously received mdpp services from G9890005004a different mdpp supplier under the mdpp expanded model. a supplier may only G9890006004receive one bridge payment per mdpp beneficiary G9891001003Mdpp session reported as a line-item on a claim for a payable mdpp expanded Em session reporting 00 9 C Y1 1 02018040120180401 A G9891002004model (em) hcpcs code for a session furnished by the billing supplier under G9891003004the mdpp expanded model and counting toward achievement of the attendance G9891004004performance goal for the payable mdpp expanded model hcpcs code (this code is G9891005004for reporting purposes only) G9892001003Documentation of patient reason(s) for not performing a dilated macular Doc pt rsn no dil mac exam 00 9 C Z2 1 02018010120180101 N G9892002004examination G9893001003Dilated macular exam was not performed, reason not otherwise specified No mac exam 00 9 C Z2 1 02018010120180101 N G9894001003Androgen deprivation therapy prescribed/administered in combination with Adr dep thrpy prescribed 00 9 C Z2 1 02018010120180101 N G9894002004external beam radiotherapy to the prostate G9895001003Documentation of medical reason(s) for not prescribing/administering androgen Doc med rsn no adr dep thrpy00 9 C Z2 1 02018010120180101 N G9895002004deprivation therapy in combination with external beam radiotherapy to the G9895003004prostate (e.g., salvage therapy) G9896001003Documentation of patient reason(s) for not prescribing/administering androgen Doc pt rsn no adr dep thrpy 00 9 C Z2 1 02018010120180101 N G9896002004deprivation therapy in combination with external beam radiotherapy to the G9896003004prostate G9897001003Patients who were not prescribed/administered androgen deprivation therapy in Pt nt prsc adr dep thrpy rng00 9 C Z2 1 02018010120180101 N G9897002004combination with external beam radiotherapy to the prostate, reason not given G9898001003Patient age 65 or older in institutional special needs plans (snp) or residing Snp/lg trm cre pt w/pos cde 00 9 C Z2 1 02018010120180101 N G9898002004in long-term care with pos code 32, 33, 34, 54, or 56 any time during the G9898003004measurement period G9899001003Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) Scrn mam perf rslts doc 00 9 C Z2 1 02018010120180101 N G9899002004mammography results documented and reviewed G9900001003Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) Scrn mam perf rslts not doc 00 9 C Z2 1 02018010120180101 N G9900002004mammography results were not documented and reviewed, reason not otherwise G9900003004specified G9901001003Patient age 65 or older in institutional special needs plans (snp) or residing Snp/lg trm cre pt w/pos cde 00 9 C Z2 1 02018010120180101 N G9901002004in long-term care with pos code 32, 33, 34, 54, or 56 any time during the G9901003004measurement period G9902001003Patient screened for tobacco use and identified as a tobacco user Pt scrn tbco and id as user 00 9 C Z2 1 02018010120180101 N G9903001003Patient screened for tobacco use and identified as a tobacco non-user Pt scrn tbco id as non user 00 9 C Z2 1 02018010120180101 N G9904001003Documentation of medical reason(s) for not screening for tobacco use (e.g., Doc med rsn no tbco scrn 00 9 C Z2 1 02018010120180101 N G9904002004limited life expectancy, other medical reason) G9905001003Patient not screened for tobacco use, reason not given No pt tbco scrn rng 00 9 C Z2 1 02018010120180101 N G9906001003Patient identified as a tobacco user received tobacco cessation intervention Pt recv tbco cess interv 00 9 C Z2 1 02018010120180101 N G9906002004(counseling and/or pharmacotherapy) G9907001003Documentation of medical reason(s) for not providing tobacco cessation Doc med rsn no tbco interv 00 9 C Z2 1 02018010120180101 N G9907002004intervention (e.g., limited life expectancy, other medical reason) G9908001003Patient identified as tobacco user did not receive tobacco cessation No pt tbco cess interv rng 00 9 C Z2 1 02018010120180101 N G9908002004intervention (counseling and/or pharmacotherapy), reason not given G9909001003Documentation of medical reason(s) for not providing tobacco cessation Doc med rsn no tbco interv 00 9 C Z2 1 02018010120180101 N G9909002004intervention if identified as a tobacco user (eg, limited life expectancy, G9909003004other medical reason) G9910001003Patients age 65 or older in institutional special needs plans (snp) or residing Snp/lg trm cre pt w/pos cde 00 9 C Z2 1 02018010120180101 N G9910002004in long-term care with pos code 32, 33, 34, 54 or 56 anytime during the G9910003004measurement period G9911001003Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or Node neg pre/post syst ther 00 9 C Z2 1 02018010120180101 N G9911002004after neoadjuvant systemic therapy G9912001003Hepatitis b virus (hbv) status assessed and results interpreted prior to Hbv status assesed and int 00 9 C Z2 1 02018010120180101 N G9912002004initiating anti-tnf (tumor necrosis factor) therapy G9913001003Hepatitis b virus (hbv) status not assessed and results interpreted prior to No hbv status assesd and int00 9 C Z2 1 02018010120180101 N G9913002004initiating anti-tnf (tumor necrosis factor) therapy, reason not given G9914001003Patient receiving an anti-tnf agent Pt receiving anti-tnf agent 00 9 C Z2 1 02018010120180101 N G9915001003No record of hbv results documented No documntd hbv results rcd 00 9 C Z2 1 02018010120180101 N G9916001003Functional status performed once in the last 12 months Funct status past 12 months 00 9 C Z2 1 02018010120180101 N G9917001003Documentation of medical reason(s) for not performing functional status (e.g., Doc med rsn no funct status 00 9 C Z2 1 02018010120180101 N G9917002004patient is severely impaired and caregiver knowledge is limited, other medical G9917003004reason) G9918001003Functional status not performed, reason not otherwise specified No funct stat perf, rsn nos 00 9 C Z2 1 02018010120180101 N G9919001003Screening performed and positive and provision of recommendations Scrn nd pos nd prov of rec 00 9 C Z2 1 02018010120180101 N G9920001003Screening performed and negative Scrning perf and negative 00 9 C Z2 1 02018010120180101 N G9921001003No screening performed, partial screening performed or positive screen without No or part scrn nd rng or os00 9 C Z2 1 02018010120180101 N G9921002004recommendations and reason is not given or otherwise specified G9922001003Safety concerns screen provided and if positive then documented mitigation Sfty cncrns scrn nd mit recs00 9 C Z2 1 02018010120180101 N G9922002004recommendations G9923001003Safety concerns screen provided and negative Safty cncrns scrn and neg 00 9 C Z2 1 02018010120180101 N G9924001003Documentation of medical reason(s) for not providing safety concerns screen or Doc med rsn no scrn or recs 00 9 C Z2 1 02018010120180101 N G9924002004for not providing recommendations, orders or referrals for positive screen G9924003004(e.g., patient in palliative care, other medical reason) G9925001003Safety concerns screening not provided, reason not otherwise specified No scrn prov rsn nos 00 9 C Z2 1 02018010120180101 N G9926001003Safety concerns screening positive screen is without provision of mitigation Sfty cncrns scrn but no recs00 9 C Z2 1 02018010120180101 N G9926002004recommendations, including but not limited to referral to other resources G9927001003Documentation of system reason(s) for not prescribing warfarin or another Doc no warf /fda pt trial 00 9 C Z2 1 02018010120180101 N G9927002004fda-approved anticoagulation due to patient being currently enrolled in a G9927003004clinical trial related to af/atrial flutter treatment G9928001003Warfarin or another fda-approved anticoagulant not prescribed, reason not given No warf or fda drug presc 00 9 C Z2 1 02018010120180101 N G9929001003Patient with transient or reversible cause of af (e.g., pneumonia, Trs/rev af 00 9 C Z2 1 02018010120180101 N G9929002004hyperthyroidism, pregnancy, cardiac surgery) G9930001003Patients who are receiving comfort care only Com care 00 9 C Z2 1 02018010120180101 N G9931001003Documentation of cha2ds2-vasc risk score of 0 or 1 No chad or chad scr 0 or 1 00 9 C Z2 1 02018010120180101 N G9932001003Documentation of patient reason(s) for not having records of negative or Doc pt rsn no tb scrn recrds00 9 C Z2 1 02018010120180101 N G9932002004managed positive tb screen (e.g., patient does not return for mantoux (ppd) G9932003004skin test evaluation) G9933001003Adenoma(s) or colorectal cancer detected during screening colonoscopy Canc detectd during col scrn00 9 C Z2 1 02018010120180101 N G9934001003Documentation that neoplasm detected is only diagnosed as traditional serrated Doc rsn not detecting cancer00 9 C Z2 1 02018010120180101 N G9934002004adenoma, sessile serrated polyp, or sessile serrated adenoma G9935001003Adenoma(s) or colorectal cancer not detected during screening colonoscopy Canc not detectd during srcn00 9 C Z2 1 02018010120180101 N G9936001003Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or Pmh plyp/neo co/rect/jun/ans00 9 C Z2 1 02018010120180101 N G9936002004other malignant neoplasm of rectum, rectosigmoid junction, and anus G9937001003Diagnostic colonoscopy Dig or surv colsco 00 9 C Z2 1 02018010120180101 N G9938001003Patients age 65 or older in institutional special needs plans (snp) or residing Snp/lg trm cre pt w/pos cde 00 9 C Z2 1 02018010120180101 N G9938002004in long-term care with pos code 32, 33, 34, 54, or 56 any time during the G9938003004measurement period G9939001003Pathologists/dermatopathologists is the same clinician who performed the biopsy Same path/derm perf biopsy 00 9 C Z2 1 02018010120180101 N G9940001003Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in Doc reas no statin therapy 00 9 C Z2 1 02018010120180101 N G9940002004vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease G9940003004during the measurement period or prior year) G9941001003Back pain was measured by the visual analog scale (vas) within three months Pre and post vas wthn 3 mos 00 9 C Z2 1 02018010120180101 N G9941002004preoperatively and at three months (6 - 20 weeks) postoperatively G9942001003Patient had any additional spine procedures performed on the same date as the Adtl spine proc on same date00 9 C Z2 1 02018010120180101 N G9942002004lumbar discectomy/laminotomy G9943001003Back pain was not measured by the visual analog scale (vas) within three months Bk pn nt msr vas scl pre/pst00 9 C Z2 1 02018010120180101 N G9943002004preoperatively and at three months ( 6 - 20 weeks) postoperatively G9944001003Back pain was measured by the visual analog scale (vas) within three months Vas 3 mon pre and 1 yr post 00 9 C Z2 1 02018010120180101 N G9944002004preoperatively and at one year (9 to 15 months) postoperatively G9945001003Patient had cancer, fracture or infection related to the lumbar spine or Pt w/cancer scoliosis 00 9 C Z2 1 02018010120180101 N G9945002004patient had idiopathic or congenital scoliosis G9946001003Back pain was not measured by the visual analog scale (vas) within three months Bk pn nt msr vas pre-pst 1y 00 9 C Z2 1 02018010120180101 N G9946002004preoperatively and at one year (9 to 15 months) postoperatively G9947001003Leg pain was measured by the visual analog scale (vas) within three months Pre and post vas wthn 3 mos 00 9 C Z2 1 02018010120180101 N G9947002004preoperatively and at three months (6 to 20 weeks) postoperatively G9948001003Patient had any additional spine procedures performed on the same date as the Adtl spine proc on same date00 9 C Z2 1 02018010120180101 N G9948002004lumbar discectomy/laminotomy G9949001003Leg pain was not measured by the visual analog scale (vas) within three months Lg pn nt msr vas scl pre/pst00 9 C Z2 1 02018010120180101 N G9949002004preoperatively and at three months (6 to 20 weeks) postoperatively G9954001003Patient exhibits 2 or more risk factors for post-operative vomiting Pt >2 rsk fac post-op vomit 00 9 C Z2 1 02018010120180101 N G9955001003Cases in which an inhalational anesthetic is used only for induction Inhlnt anesth only for induc00 9 C Z2 1 02018010120180101 N G9956001003Patient received combination therapy consisting of at least two prophylactic Combo thrpy of >= 2 prophly 00 9 C Z2 1 02018010120180101 N G9956002004pharmacologic anti-emetic agents of different classes preoperatively and/or G9956003004intraoperatively G9957001003Documentation of medical reason for not receiving combination therapy Doc med rsn no combo thrpy 00 9 C Z2 1 02018010120180101 N G9957002004consisting of at least two prophylactic pharmacologic anti-emetic agents of G9957003004different classes preoperatively and/or intraoperatively (e.g., intolerance or G9957004004other medical reason) G9958001003Patient did not receive combination therapy consisting of at least two No combo prohpyl thrp for pt00 9 C Z2 1 02018010120180101 N G9958002004prophylactic pharmacologic anti-emetic agents of different classes G9958003004preoperatively and/or intraoperatively G9959001003Systemic antimicrobials not prescribed Systemic antimicro not presc00 9 C Z2 1 02018010120180101 N G9960001003Documentation of medical reason(s) for prescribing systemic antimicrobials Med rsn sys antimi nt rx 00 9 C Z2 1 02018010120180101 N G9961001003Systemic antimicrobials prescribed Systemic antimicro presc 00 9 C Z2 1 02018010120180101 N G9962001003Embolization endpoints are documented separately for each embolized vessel and Embolization doc separatly 00 9 C Z2 1 02018010120180101 N G9962002004ovarian artery angiography or embolization performed in the presence of variant G9962003004uterine artery anatomy G9963001003Embolization endpoints are not documented separately for each embolized vessel Embolization not doc separat00 9 C Z2 1 02018010120180101 N G9963002004or ovarian artery angiography or embolization not performed in the presence of G9963003004variant uterine artery anatomy G9964001003Patient received at least one well-child visit with a pcp during the Pt recv >=1 well-chld visit 00 9 C Z2 1 02018010120180101 N G9964002004performance period G9965001003Patient did not receive at least one well-child visit with a pcp during the No well-chld vist recv by pt00 9 C Z2 1 02018010120180101 N G9965002004performance period G9966001003Children who were screened for risk of developmental, behavioral and social Scrn, inter, report child 00 9 C Z2 1 02018010120180101 N G9966002004delays using a standardized tool with interpretation and report G9967001003Children who were not screened for risk of developmental, behavioral and social No scrn, inter, reprt child 00 9 C Z2 1 02018010120180101 N G9967002004delays using a standardized tool with interpretation and report G9968001003Patient was referred to another provider or specialist during the performance Pt refrd 2 pvdr/spclst in pp00 9 C Z2 1 02018010120180101 N G9968002004period G9969001003Provider who referred the patient to another provider received a report from Pvdr rfrd pt rprt rcvd 00 9 C Z2 1 02018010120180101 N G9969002004the provider to whom the patient was referred G9970001003Provider who referred the patient to another provider did not receive a report Pvdr rfrd pt no rprt rcvd 00 9 C Z2 1 02018010120180101 N G9970002004from the provider to whom the patient was referred G9974001003Dilated macular exam performed, including documentation of the presence or Mac exam perf 00 9 C Z2 1 02018010120190101 S G9974002004absence of macular thickening or geographic atrophy or hemorrhage and the level G9974003004of macular degeneration severity G9975001003Documentation of medical reason(s) for not performing a dilated macular Doc med rsn no dil mac exam 00 9 C Z2 1 02018010120190101 S G9975002004examination G9978001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 10mins 13 A C M1A 1 02018100120181001 A G9978002004only in a medicare-approved bundled payments for care improvement advanced G9978003004(bpci advanced) model episode of care, which requires these 3 key components: a G9978004004problem focused history; a problem focused examination; and straightforward G9978005004medical decision making, furnished in real time using interactive audio and G9978006004video technology. counseling and coordination of care with other physicians, G9978007004other qualified health care professionals or agencies are provided consistent G9978008004with the nature of the problem(s) and the needs of the patient or the family or G9978009004both. usually, the presenting problem(s) are self limited or minor. typically, G997801000410 minutes are spent with the patient or family or both via real time, audio G9978011004and video intercommunications technology G9979001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 20mins 13 A C M1A 1 02018100120181001 A G9979002004only in a medicare-approved bundled payments for care improvement advanced G9979003004(bpci advanced) model episode of care, which requires these 3 key components: G9979004004an expanded problem focused history; an expanded problem focused examination; G9979005004straightforward medical decision making, furnished in real time using G9979006004interactive audio and video technology. counseling and coordination of care G9979007004with other physicians, other qualified health care professionals or agencies G9979008004are provided consistent with the nature of the problem(s) and the needs of the G9979009004patient or the family or both. usually, the presenting problem(s) are of low to G9979010004moderate severity. typically, 20 minutes are spent with the patient or family G9979011004or both via real time, audio and video intercommunications technology G9980001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 30 mins 13 A C M1A 1 02018100120181001 A G9980002004only in a medicare-approved bundled payments for care improvement advanced G9980003004(bpci advanced) model episode of care, which requires these 3 key components: a G9980004004detailed history; a detailed examination; medical decision making of low G9980005004complexity, furnished in real time using interactive audio and video G9980006004technology. counseling and coordination of care with other physicians, other G9980007004qualified health care professionals or agencies are provided consistent with G9980008004the nature of the problem(s) and the needs of the patient or the family or G9980009004both. usually, the presenting problem(s) are of moderate severity. typically, G998001000430 minutes are spent with the patient or family or both via real time, audio G9980011004and video intercommunications technology G9981001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 45mins 13 A C M1A 1 02018100120181001 A G9981002004only in a medicare-approved bundled payments for care improvement advanced G9981003004(bpci advanced) model episode of care, which requires these 3 key components: a G9981004004comprehensive history; a comprehensive examination; medical decision making of G9981005004moderate complexity, furnished in real time using interactive audio and video G9981006004technology. counseling and coordination of care with other physicians, other G9981007004qualified health care professionals or agencies are provided consistent with G9981008004the nature of the problem(s) and the needs of the patient or the family or G9981009004both. usually, the presenting problem(s) are of moderate to high severity. G9981010004typically, 45 minutes are spent with the patient or family or both via real G9981011004time, audio and video intercommunications technology G9982001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 60mins 13 A C M1A 1 02018100120181001 A G9982002004only in a medicare-approved bundled payments for care improvement advanced G9982003004(bpci advanced) model episode of care, which requires these 3 key components: a G9982004004comprehensive history; a comprehensive examination; medical decision making of G9982005004high complexity, furnished in real time using interactive audio and video G9982006004technology. counseling and coordination of care with other physicians, other G9982007004qualified health care professionals or agencies are provided consistent with G9982008004the nature of the problem(s) and the needs of the patient or the family or G9982009004both. usually, the presenting problem(s) are of moderate to high severity. G9982010004typically, 60 minutes are spent with the patient or family or both via real G9982011004time, audio and video intercommunications technology G9983001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 10mins 13 A C M1B 1 02018100120181001 A G9983002004patient for use only in a medicare-approved bundled payments for care G9983003004improvement advanced (bpci advanced) model episode of care, which requires at G9983004004least 2 of the following 3 key components: a problem focused history; a problem G9983005004focused examination; straightforward medical decision making, furnished in real G9983006004time using interactive audio and video technology. counseling and coordination G9983007004of care with other physicians, other qualified health care professionals or G9983008004agencies are provided consistent with the nature of the problem(s) and the G9983009004needs of the patient or the family or both. usually, the presenting problem(s) G9983010004are self limited or minor. typically, 10 minutes are spent with the patient or G9983011004family or both via real time, audio and video intercommunications technology G9984001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 15mins 13 A C M1B 1 02018100120181001 A G9984002004patient for use only in a medicare-approved bundled payments for care G9984003004improvement advanced (bpci advanced) model episode of care, which requires at G9984004004least 2 of the following 3 key components: an expanded problem focused history; G9984005004an expanded problem focused examination; medical decision making of low G9984006004complexity, furnished in real time using interactive audio and video G9984007004technology. counseling and coordination of care with other physicians, other G9984008004qualified health care professionals or agencies are provided consistent with G9984009004the nature of the problem(s) and the needs of the patient or the family or G9984010004both. usually, the presenting problem(s) are of low to moderate severity. G9984011004typically, 15 minutes are spent with the patient or family or both via real G9984012004time, audio and video intercommunications technology G9985001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 25mins 13 A C M1B 1 02018100120181001 A G9985002004patient for use only in a medicare-approved bundled payments for care G9985003004improvement advanced (bpci advanced) model episode of care, which requires at G9985004004least 2 of the following 3 key components: a detailed history; a detailed G9985005004examination; medical decision making of moderate complexity, furnished in real G9985006004time using interactive audio and video technology. counseling and coordination G9985007004of care with other physicians, other qualified health care professionals or G9985008004agencies are provided consistent with the nature of the problem(s) and the G9985009004needs of the patient or the family or both. usually, the presenting problem(s) G9985010004are of moderate to high severity. typically, 25 minutes are spent with the G9985011004patient or family or both via real time, audio and video intercommunications G9985012004technology G9986001003Remote in-home visit for the evaluation and management of an established Remote e/m est. pt 40mins 13 A C M1B 1 02018100120181001 A G9986002004patient for use only in a medicare-approved bundled payments for care G9986003004improvement advanced (bpci advanced) model episode of care, which requires at G9986004004least 2 of the following 3 key components: a comprehensive history; a G9986005004comprehensive examination; medical decision making of high complexity, G9986006004furnished in real time using interactive audio and video technology. G9986007004counseling and coordination of care with other physicians, other qualified G9986008004health care professionals or agencies are provided consistent with the nature G9986009004of the problem(s) and the needs of the patient or the family or both. usually, G9986010004the presenting problem(s) are of moderate to high severity. typically, 40 G9986011004minutes are spent with the patient or family or both via real time, audio and G9986012004video intercommunications technology G9987001003Bundled payments for care improvement advanced (bpci advanced) model home visit Bpci advanced in home visit 13 A C M5D 1 02018100120181001 A G9987002004for patient assessment performed by clinical staff for an individual not G9987003004considered homebound, including, but not necessarily limited to patient G9987004004assessment of clinical status, safety/fall prevention, functional G9987005004status/ambulation, medication reconciliation/management, compliance with G9987006004orders/plan of care, performance of activities of daily living, and ensuring G9987007004beneficiary connections to community and other services; for use only for a G9987008004bpci advanced model episode of care; may not be billed for a 30-day period G9987009004covered by a transitional care management code H0001001003Alcohol 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 Alcohol and/or drug preventi00 9 I Z2 9 02001010120010101 N H0028002004(e.g., 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 01986010120180101 N 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 D O1E 1P 01999010120180101 N J0131001003Injection, acetaminophen, 10 mg Acetaminophen injection 51 A C O1E 1P 02012010120140101 N J0132001003Injection, acetylcysteine, 100 mg Acetylcysteine injection 51 A C O1E 1P 02006010120180101 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 0199401012015010120141231N J0150002004adenosine phosphate compounds, instead use a9270) J0151001003Injection, adenosine for diagnostic use, 1 mg (not to be used to report any Inj adenosine diag 1mg 51 A C O1E 1P 0201401012015010120141231N J0151002004adenosine phosphate compounds, instead use a9270) J0153001003Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate Adenosine inj 1mg 51 A D 0194O1E 1P 02015010120150101 N J0153002004compounds) 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 N J0180001003Injection, agalsidase beta, 1 mg Agalsidase beta injection 51 A CYY20080101 O1E 1P 02005010120050101 N J0185001003Injection, aprepitant, 1 mg Inj., aprepitant, 1 mg 51 A CYY20190101 O1E 1 02019010120190101 A 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 02000010120160101 N J0202001003Injection, alemtuzumab, 1 mg Injection, alemtuzumab 51 A CYY20160101 O1E 1P 02016010120160101 N J0205001003Injection, alglucerase, per 10 units Alglucerase injection 51 A 2049 D 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 D O1E 1P 01984010120140101 N J0215001003Injection, alefacept, 0.5 mg Alefacept 51 A C O1E 1G 02004010120180101 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 D O1E 1P 02003010120140101 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 sulbactam 1.5 gm 51 A 2049 D O1E 1P 01995010120190101 S 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 C O1E 1P 02007010120140101 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 D 0095O1E 1P 02006010120180101 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 D O1E 1P 01999010120140101 N J0400001003Injection, aripiprazole, intramuscular, 0.25 mg Aripiprazole injection 51 A C O1E 1P 02008010120190101 P J0401001003Injection, aripiprazole, extended release, 1 mg Inj aripiprazole ext rel 1mg51 A CYY20140101 O1E 1P 02014010120140101 N J0456001003Injection, azithromycin, 500 mg Azithromycin 51 A 2049.5 D O1E 1P 02000010120000101 N 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 01982010120190101 P 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 D O1E 1P 01999010120190101 P 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 N 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 J0517001003Injection, benralizumab, 1 mg Inj., benralizumab, 1 mg 51 A CYY20190101 O1E 1 02019010120190101 A J0520001003Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg Bethanechol chloride inject 51 A 2049 D O1E 1P 01984010119970101 N J0558001003Injection, penicillin g benzathine and penicillin g procaine, 100,000 units Peng benzathine/procaine inj51 A CYY20190101 O1E 1P 02011010120190101 P J0561001003Injection, penicillin g benzathine, 100,000 units Penicillin g benzathine inj 51 A 2049 DYY20160101 O1E 1P 02011010120160101 N J0565001003Injection, bezlotoxumab, 10 mg Inj, bezlotoxumab, 10 mg 51 A CYY20180101 O1E 1P 02018010120180101 N J0567001003Injection, cerliponase alfa, 1 mg Inj., cerliponase alfa 1 mg 51 A CYY20190101 O1E 1 02019010120190101 A J0570001003Buprenorphine implant, 74.2 mg Buprenorphine implant 74.2mg51 A CYY20170101 O1E 1 02017010120170101 N J0571001003Buprenorphine, oral, 1 mg Buprenorphine oral 1mg 00 9 D 0127O1E 1P 02015010120150101 N J0572001003Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine Bupren/nal up to 3mg bupreno00 9 D 0127O1E 1P 02015010120160101 N J0573001003Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg Bupren/nal 3.1 to 6mg bupren00 9 D 0127O1E 1P 02015010120170101 N J0573002004buprenorphine J0574001003Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 Bupren/nal 6.1 to 10mg bupre00 9 D 0127O1E 1P 02015010120160101 N J0574002004mg buprenorphine J0575001003Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine Bupren/nal over 10mg bupreno00 9 D 0127O1E 1P 02015010120160101 N J0583001003Injection, bivalirudin, 1 mg Bivalirudin 51 A C O1E 1P 02004010120180101 N J0584001003Injection, burosumab-twza 1 mg Injection, burosumab-twza 1m51 A CYY20190101 O1E 1 02019010120190101 A 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 J0596001003Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units Injection, ruconest 51 A CYY20160101 O1E 1 02016010120160101 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 J0599001003Injection, c-1 esterase inhibitor (human), (haegarda), 10 units Inj., haegarda 10 units 51 A CYY20190101 O1E 1 02019010120190101 A J0600001003Injection, edetate calcium disodium, up to 1000 mg Edetate calcium disodium inj51 A 2049 DYY20080101 O1E 1P 01982010119970101 N J0604001003Cinacalcet, oral, 1 mg, (for esrd on dialysis) Cinacalcet, esrd on dialysis51 A D 0195O1E 1L 02018010120180101 N J0606001003Injection, etelcalcetide, 0.1 mg Inj, etelcalcetide, 0.1 mg 51 A DYY20180101 0195O1E 1L 02018010120180101 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 J0695001003Injection, ceftolozane 50 mg and tazobactam 25 mg Inj ceftolozane tazobactam 51 A CYY20160101 O1E 1P 02016010120160101 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 3 mg and betamethasone sodium phosphate 3 mg Betamethasone acet&sod phosp51 A 2049 D O1E 1P 01995010120080101 N J0706001003Injection, caffeine citrate, 5 mg 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 CYY20160101 O1E 1P 02012010120160101 N J0713001003Injection, ceftazidime, per 500 mg Inj ceftazidime per 500 mg 51 A 2049 D O1E 1P 01996010119970101 N J0714001003Injection, ceftazidime and avibactam, 0.5 g/0.125 g Ceftazidime and avibactam 51 A CYY20160101 O1E 1P 02016010120160101 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 N J0717001003Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug Certolizumab pegol inj 1mg 51 A CYY20140101 O1E 1P 02014010120140101 N J0717002004administered under the direct supervision of a physician, not for use when drug J0717003004is self administered) J0720001003Injection, chloramphenicol sodium succinate, up to 1 gm Chloramphenicol sodium injec51 A 2049 D O1E 1P 01982010120180101 N J0725001003Injection, chorionic gonadotropin, per 1,000 usp units Chorionic gonadotropin/1000u51 A 2049 DYY20190101 O1E 1P 01986010120190101 P 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 1 mg Colchicine injection 51 A 2049 D O1E 1P 0198201012017010120161231N 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 D O1E 1P 01982010120190101 P J0833001003Injection, cosyntropin, not otherwise specified, 0.25 mg Cosyntropin injection nos 51 A C O1E 1P 0201001012019010120181231D J0834001003Injection, cosyntropin, 0.25 mg Inj., cosyntropin, 0.25 mg 51 A C O1E 1P 02010010120190101 C J0840001003Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram Crotalidae poly immune fab 51 A CYY20120101 O1E 1P 02012010120120101 N J0841001003Injection, crotalidae immune f(ab')2 (equine), 120 mg Inj crotalidae im f(ab')2 eq51 A CYY20190101 O1E 1P 02019010120190101 A J0850001003Injection, cytomegalovirus immune globulin intravenous (human), per vial Cytomegalovirus imm iv /vial51 A 2049 DYY20080101 O1E 1P 01982010119970101 N J0875001003Injection, dalbavancin, 5 mg Injection, dalbavancin 51 A CYY20160101 O1E 1P 02016010120160101 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 DYY20170101 O1E 1L 02006010120170101 N J0883001003Injection, argatroban, 1 mg (for non-esrd use) Argatroban nonesrd use 1mg 51 A 2049 4273.1 DYY20170101 O1E 9 02017010120170101 N J0884001003Injection, argatroban, 1 mg (for esrd on dialysis) Argatroban esrd dialysis 1mg51 A 2049 4273.1 DYY20180101 O1E 1L 02017010120180101 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 0200601012016010120151231N J0887001003Injection, epoetin beta, 1 microgram, (for esrd on dialysis) Epoetin beta esrd use 57 A D 0195O1E 1L 02015010120150101 N J0888001003Injection, epoetin beta, 1 microgram, (for non esrd use) Epoetin beta non esrd 57 A D 0195O1E 9 02015010120190101 P J0890001003Injection, peginesatide, 0.1 mg (for esrd on dialysis) Peginesatide injection 51 A C O1E 1P 02013010120130101 N 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 D O1E 1P 0198201012015010120141231N J0945001003Injection, brompheniramine maleate, per 10 mg Brompheniramine maleate inj 51 A 2049 D O1E 1P 01982010119970101 N 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 N J1060001003Injection, testosterone cypionate and estradiol cypionate, up to 1 ml Testosterone cypionate 1 ml 51 A 2049 D O1E 1P 0198201012015010120141231N J1070001003Injection, testosterone cypionate, up to 100 mg Testosterone cypionat 100 mg51 A 2049 D O1E 1P 0198201012015010120141231N J1071001003Injection, testosterone cypionate, 1 mg Inj testosterone cypionate 51 A D 0194O1E 1P 02015010120150101 N J1080001003Injection, testosterone cypionate, 1 cc, 200 mg Testosterone cypionat 200 mg51 A 2049 D O1E 1P 0198201012015010120141231N J1094001003Injection, dexamethasone acetate, 1 mg Inj dexamethasone acetate 51 A 2049 D O1E 1P 02003010120030101 N J1100001003Injection, dexamethasone sodium phosphate, 1 mg 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 01982010120190101 P J1120001003Injection, acetazolamide sodium, up to 500 mg Acetazolamid sodium injectio51 A 2049 D O1E 1P 01982010119970101 N J1130001003Injection, diclofenac sodium, 0.5 mg Inj diclofenac sodium 0.5mg 51 A C O1E 1 02017010120190101 P 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 D O1E 1P 01982010120180101 N J1212001003Injection, dmso, dimethyl sulfoxide, 50%, 50 ml Dimethyl sulfoxide 50% 50 ml51 A45-23 2049 DYY20170101 O1E 1P 01986010120170101 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 J1301001003Injection, edaravone, 1 mg Injection, edaravone, 1 mg 51 A CYY20190101 O1E 1 02019010120190101 A J1320001003Injection, amitriptyline hcl, up to 20 mg Amitriptyline injection 51 A 2049 D O1E 1P 01982010119970101 N J1322001003Injection, elosulfase alfa, 1 mg Elosulfase alfa, injection 51 A CYY20150101 O1E 1P 02015010120150101 N J1324001003Injection, enfuvirtide, 1 mg Enfuvirtide injection 51 A C O1E 1P 02007010120180101 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 DYY20170101 O1E 1P 01995010120170101 N J1380001003Injection, estradiol valerate, up to 10 mg Estradiol valerate 10 mg inj51 A 2049 D O1E 1P 01982010119970101 N J1410001003Injection, estrogen conjugated, per 25 mg Inj estrogen conjugate 25 mg51 A 2049 DYY20170101 O1E 1P 01982010120170101 N J1428001003Injection, eteplirsen, 10 mg Inj, eteplirsen, 10 mg 51 A CYY20180101 O1E 1P 02018010120180101 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 D O1E 1P 01982010120140101 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) J1439001003Injection, ferric carboxymaltose, 1 mg Inj ferric carboxymaltos 1mg51 A CYY20150101 O1E 1P 02015010120150101 N J1442001003Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram Inj filgrastim excl biosimil51 A DYY20140101 0187O1E 1P 02014010120160101 N J1443001003Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron Inj ferric pyrophosphate cit51 A C O1E 1L 02016010120160101 N J1446001003Injection, tbo-filgrastim, 5 micrograms Inj, tbo-filgrastim, 5 mcg 51 A D 0187O1E 1P 0201401012016010120151231N J1447001003Injection, tbo-filgrastim, 1 microgram Inj tbo filgrastim 1 microg 51 A 2049.5 DYY20160101 O1E 1P 02016010120160101 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 D O1E 1P 02001010120140101 N J1453001003Injection, fosaprepitant, 1 mg Fosaprepitant injection 51 A CYY20090101 O1E 1P 02009010120090101 N J1454001003Injection, fosnetupitant 235 mg and palonosetron 0.25 mg Inj fosnetupitant, palonoset51 A DYY20190101 0204O1E 1 02019010120190101 A J1455001003Injection, foscarnet sodium, per 1000 mg Foscarnet sodium injection 51 A 2049 DYY20170101 O1E 1P 01993010120170101 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 DYY20170101 O1E 1P 01984010120170101 N J1555001003Injection, immune globulin (cuvitru), 100 mg Inj cuvitru, 100 mg 51 A CYY20180101 D1G 1P 02018010120180101 N J1556001003Injection, immune globulin (bivigam), 500 mg Inj, imm glob bivigam, 500mg51 A CYY20140101 O1E 1P 02014010120140101 N 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 DYY20170101 O1E 1P 01984010120170101 N J1561001003Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., Gamunex-c/gammaked 51 A 2049 DYY20080101 O1E 1P 02008010120130101 N J1561002004liquid), 500 mg J1562001003Injection, immune globulin (vivaglobin), 100 mg Vivaglobin, inj 51 A C O1E 1P 02007010120080101 N 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 N J1569002004liquid), 500 mg J1570001003Injection, ganciclovir sodium, 500 mg Ganciclovir sodium injection51 A 2049 D 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 J1575001003Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin Hyqvia 100mg immuneglobulin 51 A CYY20160101 O1E 1P 02016010120160101 N J1580001003Injection, garamycin, gentamicin, up to 80 mg Garamycin gentamicin inj 51 A 2049 D O1E 1P 01984010119970101 N J1590001003Injection, gatifloxacin, 10 mg Gatifloxacin injection 51 A C O1E 1P 0200201012017010120161231N 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 01982010120160101 N J1602001003Injection, golimumab, 1 mg, for intravenous use Golimumab for iv use 1mg 51 A CYY20140101 O1E 1P 02014010120140101 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 D O1E 1P 01982010120140101 N J1626001003Injection, granisetron hydrochloride, 100 mcg Granisetron hcl injection 51 A 2049 D O1E 1P 01998010120090101 N J1627001003Injection, granisetron, extended-release, 0.1 mg Inj, granisetron, xr, 0.1 mg51 A CYY20180101 O1E 1P 02018010120180101 N J1628001003Injection, guselkumab, 1 mg Inj., guselkumab, 1 mg 51 A CYY20190101 O1E 1 02019010120190101 A 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 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 caproate00 9 IYY20120101 O1E 1P 0201201012018010120171231N J1726001003Injection, hydroxyprogesterone caproate, (makena), 10 mg Makena, 10 mg 51 A CYY20180101 O1E 1P 02018010120180101 N J1729001003Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg Inj hydroxyprogst capoat nos51 A C O1E 1P 02018010120180101 N J1730001003Injection, diazoxide, up to 300 mg Diazoxide injection 51 A 2049 D O1E 1P 01982010120180101 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 N 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 N J1745001003Injection, infliximab, excludes biosimilar, 10 mg Infliximab not biosimil 10mg51 A 2049 DYY20080101 O1E 1P 02000010120170101 N J1746001003Injection, ibalizumab-uiyk, 10 mg Inj., ibalizumab-uiyk, 10 mg51 A CYY20190101 O1E 1 02019010120190101 A 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 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 J1826001003Injection, interferon beta-1a, 30 mcg Interferon beta-1a inj 00 9 CYY20170101 O1E 1 02011010120170101 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 drug J1830003004is self administered) J1833001003Injection, isavuconazonium, 1 mg Injection, isavuconazonium 51 A CYY20160101 O1E 1 02016010120160101 N J1835001003Injection, itraconazole, 50 mg Itraconazole injection 51 A C 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 CYY20150101 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 J1942001003Injection, aripiprazole lauroxil, 1 mg Aripiprazole lauroxil 1mg 51 A CYY20170101 O1E 1 02017010120170101 N J1945001003Injection, lepirudin, 50 mg Lepirudin 51 A 2049 D 0095O1E 1P 02006010120180101 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, 200 mg Linezolid injection 51 A C O1E 1P 02002010120180101 N J2060001003Injection, lorazepam, 2 mg Lorazepam injection 51 A 2049 D O1E 1P 01982010119970101 N J2062001003Loxapine for inhalation, 1 mg Loxapine for inhalation 1 mg51 A CYY20190101 O1E 1 02019010120190101 A 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 J2182001003Injection, mepolizumab, 1 mg Injection, mepolizumab, 1mg 51 A CYY20170101 O1E 1 02017010120170101 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 C O1E 1P 02013010120130101 N J2248001003Injection, micafungin sodium, 1 mg Micafungin sodium injection 51 A C O1E 1P 02007010120160101 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 01986010120180101 N J2265001003Injection, minocycline hydrochloride, 1 mg Minocycline hydrochloride 51 A CYY20170101 O1E 1P 02012010120170101 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 100mg00 9 I O1E 1P 0199901012015010120141231N J2274001003Injection, morphine sulfate, preservative-free for epidural or intrathecal use, Inj morphine pf epid ithc 51 A60-14 2049 D O1E 1P 02015010120180101 N J227400200410 mg J2275001003Injection, morphine sulfate (preservative-free sterile solution), per 10 mg Morphine sulfate injection 00 9 I O1E 1P 0199301012015010120141231N 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 DYY20150101 O1E 1P 01986010119970101 N 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 J2326001003Injection, nusinersen, 0.1 mg Inj, nusinersen, 0.1mg 51 A CYY20180101 O1E 1P 02018010120180101 N J2350001003Injection, ocrelizumab, 1 mg Injection, ocrelizumab, 1 mg51 A CYY20180101 O1E 1P 02018010120180101 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 C O1E 1P 02011010120180101 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 J2407001003Injection, oritavancin, 10 mg Injection, oritavancin 51 A 2049 DYY20160101 0127O1E 1P 02016010120160101 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 J2502001003Injection, pasireotide long acting, 1 mg Inj, pasireotide long acting51 A CYY20160101 O1E 1 02016010120160101 N J2503001003Injection, pegaptanib sodium, 0.3 mg Pegaptanib sodium injection 51 A C 0095O1E 1P 02006010120190101 P 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 01982010120180101 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 DYY20170101 O1E 1P 01982010120170101 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 J2547001003Injection, peramivir, 1 mg Injection, peramivir 51 A CYY20160101 O1E 1P 02016010120160101 N 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 01986010120180101 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 D O1E 1P 01982010120140101 N J2704001003Injection, propofol, 10 mg Inj, propofol, 10 mg 51 A C O1E 1P 02015010120150101 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 D O1E 1P 01995010120140101 N J2730001003Injection, pralidoxime chloride, up to 1 gm Pralidoxime chloride inj 51 A 2049 D O1E 1P 01986010120180101 N J2760001003Injection, phentolamine mesylate, up to 5 mg Phentolaine mesylate inj 51 A 2049 DYY20140101 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 C O1E 1P 02009010120140101 N J2786001003Injection, reslizumab, 1 mg Injection, reslizumab, 1mg 51 A CYY20170101 O1E 1 02017010120170101 N J2788001003Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) Rho d immune globulin 50 mcg51 A 2049 D O1E 1P 02003010120140101 N J2790001003Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) Rho d immune globulin inj 51 A 2049 D O1E 1P 01986010120140101 N J2791001003Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or Rhophylac injection 51 A 2049 D O1E 1P 02008010120160101 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 D O1E 1P 02010010120190101 P 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 J2797001003Injection, rolapitant, 0.5 mg Inj., rolapitant, 0.5 mg 51 A DYY20190101 0127O1E 1P 02019010120190101 A 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 J2840001003Injection, sebelipase alfa, 1 mg Inj sebelipase alfa 1 mg 51 A CYY20170101 O1E 1 02017010120170101 N J2850001003Injection, secretin, synthetic, human, 1 microgram Inj secretin synthetic human51 A 2049 DYY20080101 O1E 1P 02006010120060101 N J2860001003Injection, siltuximab, 10 mg Injection, siltuximab 51 A CYY20160101 O1E 1P 02016010120160101 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 D O1E 1P 02002010120190101 P 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 injection 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) J3060001003Injection, taliglucerase alfa, 10 units Inj, taliglucerase alfa 10 u51 A CYY20140101 O1E 1P 02014010120140101 N J3070001003Injection, pentazocine, 30 mg Pentazocine injection 51 A 2049 D O1E 1P 01982010120190101 P J3090001003Injection, tedizolid phosphate, 1 mg Inj tedizolid phosphate 51 A CYY20160101 O1E 1P 02016010120160101 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 0198201012015010120141231N J3121001003Injection, testosterone enanthate, 1 mg Inj testostero enanthate 1mg51 A D 0194O1E 1P 02015010120150101 N J3130001003Injection, testosterone enanthate, up to 200 mg Testosterone enanthate inj 51 A 2049 D O1E 1P 0198201012015010120141231N J3140001003Injection, testosterone suspension, up to 50 mg Testosterone suspension inj 51 A 2049 D O1E 1P 0198201012015010120141231N J3145001003Injection, testosterone undecanoate, 1 mg Testosterone undecanoate 1mg51 A DYY20150101 0127O1E 1 02015010120150101 N J3150001003Injection, testosterone propionate, up to 100 mg Testosteron propionate inj 51 A 2049 D O1E 1P 0198201012015010120141231N 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 J3245001003Injection, tildrakizumab, 1 mg Inj., tildrakizumab, 1 mg 51 A C O1E 1P 02019010120190101 A J3246001003Injection, tirofiban hcl, 0.25 mg 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 5 mg Triamcinolone diacetate inj 51 A 2049 D O1E 1P 01991010119970101 N J3303001003Injection, triamcinolone hexacetonide, per 5 mg Triamcinolone hexacetonl inj51 A 2049 D O1E 1P 01991010119970101 N J3304001003Injection, triamcinolone acetonide, preservative-free, extended-release, Inj triamcinolone ace xr 1mg51 A DYY20190101 0127O1E 1P 02019010120190101 A J3304002004microsphere formulation, 1 mg 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 D O1E 1P 01982010120140101 N J3315001003Injection, triptorelin pamoate, 3.75 mg Triptorelin pamoate 51 A 2049 DYY20080101 O1E 1P 02003010120030101 N J3316001003Injection, triptorelin, extended-release, 3.75 mg Inj., triptorelin xr 3.75 mg51 A 2049 DYY20190101 O1E 1 02019010120190101 A 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 D O1E 1P 01986010120160101 N J3355001003Injection, urofollitropin, 75 iu Urofollitropin, 75 iu 51 A 2049 D 0095O1E 1P 02006010120180101 N J3357001003Ustekinumab, for subcutaneous injection, 1 mg Ustekinumab sub cu inj, 1 mg51 A CYY20110101 O1E 1P 02011010120170101 N J3358001003Ustekinumab, for intravenous injection, 1 mg Ustekinumab, iv inject, 1 mg51 A Q9989 CYY20180101 O1E 1P 02018010120180101 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 D O1E 1P 01992010120180101 N J3370001003Injection, vancomycin hcl, 500 mg Vancomycin hcl injection 51 A60-14 2049 D O1E 1P 01986010120000101 N J3380001003Injection, vedolizumab, 1 mg Injection, vedolizumab 51 A DYY20160101 0127O1E 1P 02016010120160101 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 J3397001003Injection, vestronidase alfa-vjbk, 1 mg Inj., vestronidase alfa-vjbk51 A CYY20190101 O1E 1 02019010120190101 A J3398001003Injection, voretigene neparvovec-rzyl, 1 billion vector genomes Inj luxturna 1 billion vec g51 A CYY20190101 O1E 1 02019010120190101 A 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 D O1E 1P 02004010120190101 P 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 02001010120160101 N J3486001003Injection, ziprasidone mesylate, 10 mg Ziprasidone mesylate 51 A C O1E 1P 02004010120040101 N J3489001003Injection, zoledronic acid, 1 mg Zoledronic acid 1mg 51 A C O1E 1P 02014010120180101 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 J3591001003Unclassified drug or biological used for esrd on dialysis Esrd on dialysi drug/bio noc51 A C O1E 1 02019010120190101 A 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 J71210010035% dextrose in lactated ringers infusion, up to 1000 cc 5% dextrose in lac ringers 51 A 2049 D O1E 1P 02016010120160101 N J7131001003Hypertonic saline solution, 1 ml Hypertonic saline sol 51 A 2049 D O1E 1P 02012010120120101 N J7170001003Injection, emicizumab-kxwh, 0.5 mg Inj., emicizumab-kxwh 0.5 mg51 A CYY20190101 O1E 1 02019010120190101 A J7175001003Injection, factor x, (human), 1 i.u. Inj, factor x, (human), 1iu 51 A CYY20170101 O1E 1 02017010120170101 N J7177001003Injection, human fibrinogen concentrate (fibryga), 1 mg Inj., fibryga, 1 mg 51 A CYY20190101 O1E 1 02019010120190101 A J7178001003Injection, human fibrinogen concentrate, not otherwise specified, 1 mg Inj human fibrinogen con nos51 A CYY20140401 O1E 1P 02013010120190101 C J7179001003Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco Vonvendi inj 1 iu vwf:rco 51 A DYY20170101 0211O1E 1 02017010120170101 N J7180001003Injection, factor xiii (antihemophilic factor, human), 1 i.u. Factor xiii anti-hem factor 51 A CYY20160101 O1E 1P 02012010120160101 N J7181001003Injection, factor xiii a-subunit, (recombinant), per iu Factor xiii recomb a-subunit51 A CYY20150101 O1E 1P 02015010120150101 N J7182001003Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per Factor viii recomb novoeight51 A CYY20170101 O1E 1P 02015010120170101 N J7182002004iu J7183001003Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco Wilate injection 51 A 2049 DYY20120101 O1E 1 02012010120120101 N 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 J7188001003Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. Factor viii recomb obizur 51 A 2049 DYY20160101 0127O1E 1 02016010120160101 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 01996010120180101 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 J7195001003Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise Factor ix recombinant nos 51 A 2049 DYY20080101 O1E 1P 02002010120150101 N J7195002004specified J7196001003Injection, antithrombin recombinant, 50 i.u. Antithrombin recombinant 51 A C O1E 1P 02011010120180101 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 J7200001003Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu Factor ix recombinan rixubis51 A 2049 DYY20150101 O1E 1P 02015010120150101 N J7201001003Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u. Factor ix alprolix recomb 51 A 2049 DYY20150101 O1E 1P 02015010120170101 N J7202001003Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. Factor ix idelvion inj 51 A DYY20170101 0211O1E 1 02017010120170101 N J7203001003Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, Factor ix recomb gly rebinyn51 A 2049 DYY20190101 O1E 1P 02019010120190101 A J7203002004(rebinyn), 1 iu J7205001003Injection, factor viii fc fusion protein (recombinant), per iu Factor viii fc fusion recomb51 A DYY20160101 0127O1E 1P 02016010120160101 N J7207001003Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. Factor viii pegylated recomb51 A DYY20170101 0127O1E 1 02017010120170101 N J7209001003Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. Factor viii nuwiq recomb 1iu51 A CYY20170101 O1E 1 02017010120170101 N J7210001003Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. Inj, afstyla, 1 i.u. 51 A CYY20180101 O1E 1 02018010120180101 N J7211001003Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.Inj, kovaltry, 1 i.u. 51 A CYY20180101 O1E 1 02018010120180101 N J7296001003Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg Kyleena, 19.5 mg 00 9 1862(a)(1) Q9984 S P6C 9 02018010120180101 N J7297001003Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg Liletta, 52 mg 00 9 1862(a)(1) S P6C 9 02016010120170101 N J7298001003Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg Mirena, 52 mg 00 9 1862(a)(1) S P6C 9 02016010120170101 N J7300001003Intrauterine copper contraceptive Intraut copper contraceptive00 9 1862A1 S P6C 9 01986010119960101 N J7301001003Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg Skyla, 13.5 mg 00 9 1862(a)(1) S P6C 9 02014010120170101 N J7302001003Levonorgestrel-releasing intrauterine contraceptive system, 52 mg Levonorgestrel iu 52 mg 00 9 1862a1 S P6C 9 0200201012016010120151231N 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 D 0165O1E 9 02011010120180101 N J7310001003Ganciclovir, 4.5 mg, long-acting implant Ganciclovir long act implant51 A 2049 D O1E 9 01997010120180101 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 J7313001003Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg Fluocinol acet intravit imp 51 A CYY20160101 O1E 1 02016010120160101 N J7315001003Mitomycin, ophthalmic, 0.2 mg Ophthalmic mitomycin 51 A C O1E 1P 02013010120160101 N J7316001003Injection, ocriplasmin, 0.125 mg Inj, ocriplasmin, 0.125 mg 51 A CYY20140101 O1E 1P 02014010120140101 N J7318001003Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg Inj, durolane 1 mg 51 A CYY20190101 O1E 1 02019010120190101 A J7320001003Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg Genvisc 850, inj, 1mg 51 A CYY20180101 O1E 1 02017010120180101 N J7321001003Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular Hyalgan supartz visco-3 dose51 A CYY20080101 O1E 1 02008010120180101 N J7321002004injection, per dose J7322001003Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg Hymovis injection 1 mg 51 A CYY20170101 O1E 1 02017010120170101 N 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 1 02010010120170101 N J7325002004injection, 1 mg J7326001003Hyaluronan or derivative, gel-one, for intra-articular injection, per dose Gel-one 51 A CYY20120101 O1E 1 02012010120170101 N J7327001003Hyaluronan or derivative, monovisc, for intra-articular injection, per dose Monovisc inj per dose 51 A CYY20150101 O1E 1 02015010120150101 N J7328001003Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg Gelsyn-3 injection 0.1 mg 51 A CYY20180101 O1E 1 02016010120180101 N J7329001003Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg Inj, trivisc 1 mg 51 A C O1E 1 02019010120190101 A 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 C O1E 9 0201101012015010120141231N J7336001003Capsaicin 8% patch, per square centimeter Capsaicin 8% patch 51 A CYY20150101 O1E 9 02015010120150101 N J7340001003Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml Carbidopa levodopa ent 100ml51 A C O1E P 02016010120190101 P J7342001003Instillation, ciprofloxacin otic suspension, 6 mg Ciprofloxacin otic susp 6 mg51 A CYY20170101 O1E 1 02017010120170101 N J7345001003Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg Aminolevulinic acid, 10% gel51 A DYY20180101 0213O1E 1 02018010120180101 N J7500001003Azathioprine, 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 J7503001003Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg Tacrol envarsus ex rel oral 51 A 2049.5 D O1E 1G 02016010120190101 P 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 D O1E 1G 01988010120190101 P J7506001003Prednisone, oral, per 5 mg Prednisone oral 51 A 2049.5 D O1E 1G 0198901012016010120151231N J7507001003Tacrolimus, immediate release, oral, 1 mg Tacrolimus imme rel oral 1mg51 A 2049.5 D O1E 1G 01995010120140101 N J7508001003Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg Tacrol astagraf ex rel oral 51 A 2049.5 D O1E 1G 02014010120180101 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, 25 mg Antithymocyte globuln rabbit51 A CYY20080101 O1E 1G 02002010120020101 N J7512001003Prednisone, immediate release or delayed release, oral, 1 mg Prednisone ir or dr oral 1mg51 A 2049.5 D O1E 1G 02016010120160101 N J7513001003Daclizumab, parenteral, 25 mg Daclizumab, parenteral 51 A 2049.5 D O1E 1G 01999010120180101 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 D O1G 1G 02013010120140101 N 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 J7608001003Acetylcysteine, inhalation solution, fda-approved final product, Acetylcysteine non-comp unit51 A D 0135D1G 1P 02000010120080101 N J7608002004non-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 N 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 J7999001003Compounded drug, not otherwise classified Compounded drug, noc 51 A D 0205O1E 1 02016010120160101 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 D 0119O1E 1 02005010120190101 P J8510001003Busulfan; oral, 2 mg Oral busulfan 51 A 2049.5 D O1D 1P 02000010120180101 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 D O1D 1P 02000010120160101 N J8521001003Capecitabine, oral, 500 mg Capecitabine, oral, 500 mg 51 A 2049.5 D O1D 1P 02000010120160101 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 J8562001003Fludarabine phosphate, oral, 10 mg Oral fludarabine phosphate 51 A CYY20190101 O1D 9 02011010120190101 P J8565001003Gefitinib, oral, 250 mg Gefitinib oral 00 9 D 0127O1E 9 02005010120150101 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 DYY20190101 O1D 1P 01995010120190101 P 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 C O1E 1G 02007010120180101 N J8655001003Netupitant 300 mg and palonosetron 0.5 mg, oral Oral netupitant, palonosetro51 A DYY20160101 0204O1E 1 02016010120190101 C J8670001003Rolapitant, oral, 1 mg Rolapitant, oral, 1mg 51 A DYY20170101 0211O1E 1 02017010120170101 N J8700001003Temozolomide, oral, 5 mg Temozolomide 51 A 2049.5C D O1D 1P 02001010120180101 N J8705001003Topotecan, oral, 0.25 mg Topotecan oral 51 A C O1D 1P 02009010120190101 P J8999001003Prescription drug, oral, chemotherapeutic, nos Oral prescription drug chemo51 A 2049.5 D O1D 1P 01995010119970101 N J9000001003Injection, doxorubicin hydrochloride, 10 mg Doxorubicin hcl injection 51 A 2049 D O1D 1P 01984010120090101 N J9010001003Injection, alemtuzumab, 10 mg Alemtuzumab injection 00 9 J0202 I O1E 1P 0200301012016010120151231N 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 N J9020001003Injection, asparaginase, not otherwise specified, 10,000 units Asparaginase, nos 51 A 2049 D O1D 1P 01984010120160101 N J9022001003Injection, atezolizumab, 10 mg Inj, atezolizumab,10 mg 51 A CYY20180101 O1D 1P 02018010120180101 N J9023001003Injection, avelumab, 10 mg Injection, avelumab, 10 mg 51 A CYY20180101 O1E 1 02018010120180101 N 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 J9032001003Injection, belinostat, 10 mg Injection, belinostat, 10mg 51 A CYY20160101 O1D 1P 02016010120160101 N J9033001003Injection, bendamustine hcl (treanda), 1 mg Inj., treanda 1 mg 51 A CYY20090101 O1D 1P 02009010120170101 N J9034001003Injection, bendamustine hcl (bendeka), 1 mg Inj., bendeka 1 mg 51 A CYY20170101 O1D 1P 02017010120170101 N J9035001003Injection, bevacizumab, 10 mg Bevacizumab injection 51 A CYY20080101 O1E 1P 02005010120050101 N J9039001003Injection, blinatumomab, 1 microgram Injection, blinatumomab 51 A CYY20160101 O1D 1P 02016010120160101 N J9040001003Injection, bleomycin sulfate, 15 units Bleomycin sulfate injection 51 A 2049 D O1D 1P 01984010120090101 N J9041001003Injection, bortezomib (velcade), 0.1 mg Inj., velcade 0.1 mg 51 A CYY20080101 O1E 1P 02005010120190101 C J9042001003Injection, brentuximab vedotin, 1 mg Brentuximab vedotin inj 51 A CYY20130101 O1D 1P 02013010120130101 N J9043001003Injection, cabazitaxel, 1 mg Cabazitaxel injection 51 A CYY20120101 O1D 1P 02012010120120101 N J9044001003Injection, bortezomib, not otherwise specified, 0.1 mg Inj, bortezomib, nos, 0.1 mg51 A CYY20190101 O1E 1P 02019010120190101 A J9045001003Injection, carboplatin, 50 mg Carboplatin injection 51 A 2049 D O1D 1P 01990010120090101 N J9047001003Injection, carfilzomib, 1 mg Injection, carfilzomib, 1 mg51 A CYY20140101 O1D 1P 02014010120140101 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 J9057001003Injection, copanlisib, 1 mg Inj., copanlisib, 1 mg 51 A CYY20190101 O1D 1P 02019010120190101 A J9060001003Injection, cisplatin, powder or solution, 10 mg Cisplatin 10 mg injection 51 A 2049 D O1D 1P 01984010120110101 N 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 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 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 J9145001003Injection, daratumumab, 10 mg Injection, daratumumab 10 mg51 A 2049 DYY20170101 O1D 1P 02017010120170101 N 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 DYY20190101 O1D 1P 01999010120190101 P J9153001003Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine Inj daunorubicin, cytarabine51 A CYY20190101 O1D 1 02019010120190101 A J9155001003Injection, degarelix, 1 mg Degarelix injection 51 A CYY20100101 O1E 1P 02010010120100101 N J9160001003Injection, denileukin diftitox, 300 micrograms Denileukin diftitox inj 51 A C O1E 1P 02001010120090101 N J9165001003Injection, diethylstilbestrol diphosphate, 250 mg Diethylstilbestrol injection51 A 2049 D O1D 1P 01988010120090101 N J9171001003Injection, docetaxel, 1 mg Docetaxel injection 51 A 2049 DYY20100101 O1E 1P 02010010120100101 N J9173001003Injection, durvalumab, 10 mg Inj., durvalumab, 10 mg 51 A CYY20190101 O1E 1 02019010120190101 A J9175001003Injection, elliotts' b solution, 1 ml Elliotts b solution per ml 51 A 2049 D 0095O1E 1P 02006010120060101 N J9176001003Injection, elotuzumab, 1 mg Injection, elotuzumab, 1mg 51 A CYY20170101 O1E 1 02017010120170101 N J9178001003Injection, epirubicin hcl, 2 mg Inj, epirubicin hcl, 2 mg 51 A C O1E 1P 02004010120140101 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 D O1D 1P 01994010120190101 P J9190001003Injection, fluorouracil, 500 mg Fluorouracil injection 51 A 2049 D O1D 1P 01984010120090101 N J9200001003Injection, floxuridine, 500 mg Floxuridine injection 51 A 2049 D O1D 1P 01984010120180101 N J9201001003Injection, gemcitabine hydrochloride, 200 mg Gemcitabine hcl injection 51 A 2049 D O1D 1P 01998010120140101 N J9202001003Goserelin acetate implant, per 3.6 mg Goserelin acetate implant 51 A 2049 DYY20080101 O1D 1P 01991010119970101 N J9203001003Injection, gemtuzumab ozogamicin, 0.1 mg Gemtuzumab ozogamicin 0.1 mg51 A CYY20180101 O1D 1P 02018010120180101 N J9205001003Injection, irinotecan liposome, 1 mg Inj irinotecan liposome 1 mg51 A 2049 DYY20170101 O1D 1 02017010120170101 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 D O1D 1P 01990010120180101 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 D O1D 1P 01993010120190101 P J9212001003Injection, interferon alfacon-1, recombinant, 1 microgram Interferon alfacon-1 inj 51 A 2049 D O1E 1P 01999010120140101 N J9213001003Injection, interferon, alfa-2a, recombinant, 3 million units Interferon alfa-2a inj 51 A 2049 DYY20190101 O1D G 01993010120190101 P 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 D O1D G 01993010120190101 P 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 D 0014O1D 1P 01990010120190101 P J9219001003Leuprolide acetate implant, 65 mg Leuprolide acetate implant 51 A 2049 D O1D 1P 02001010120180101 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 J9229001003Injection, inotuzumab ozogamicin, 0.1 mg Inj inotuzumab ozogam 0.1 mg51 A CYY20190101 O1E 1 02019010120190101 A 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 J9262001003Injection, omacetaxine mepesuccinate, 0.01 mg Inj, omacetaxine mep, 0.01mg51 A CYY20140101 O1D 1P 02014010120140101 N J9263001003Injection, oxaliplatin, 0.5 mg Oxaliplatin 51 A C O1D 1P 02004010120180101 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 0199401012015010120141231N J9266001003Injection, pegaspargase, per single dose vial Pegaspargase injection 51 A 2049 DYY20080101 O1D 1P 01996010120090101 N J9267001003Injection, paclitaxel, 1 mg Paclitaxel injection 51 A D 0194O1D 1P 02015010120150101 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 DYY20190101 O1D 1P 01984010120190101 P J9271001003Injection, pembrolizumab, 1 mg Inj pembrolizumab 51 A CYY20160101 O1D 1P 02016010120160101 N J9280001003Injection, mitomycin, 5 mg Mitomycin injection 51 A 2049 DYY20080101 O1D 1P 01986010120130101 N J9285001003Injection, olaratumab, 10 mg Inj, olaratumab, 10 mg 51 A CYY20180101 O1D 1 02018010120180101 N J9293001003Injection, mitoxantrone hydrochloride, per 5 mg Mitoxantrone hydrochl / 5 mg51 A 2049 DYY20080101 O1D 1P 01990010119970101 N J9295001003Injection, necitumumab, 1 mg Injection, necitumumab, 1 mg51 A CYY20170101 O1D 1 02017010120170101 N J9299001003Injection, nivolumab, 1 mg Injection, nivolumab 51 A DYY20160101 0127O1D 1P 02016010120160101 N J9300001003Injection, gemtuzumab ozogamicin, 5 mg Gemtuzumab ozogamicin inj 51 A C O1D 1P 0200201012018010120171231N J9301001003Injection, obinutuzumab, 10 mg Obinutuzumab inj 51 A CYY20150101 O1D 1P 02015010120150101 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 J9306001003Injection, pertuzumab, 1 mg Injection, pertuzumab, 1 mg 51 A CYY20140101 O1D 1 02014010120140101 N J9307001003Injection, pralatrexate, 1 mg Pralatrexate injection 51 A CYY20110101 O1E 1P 02011010120110101 N J9308001003Injection, ramucirumab, 5 mg Injection, ramucirumab 51 A CYY20160101 O1D 1P 02016010120160101 N J9310001003Injection, rituximab, 100 mg Rituximab injection 51 A 2049 DYY20080101 O1D 1P 0199901012019010120181231D J9311001003Injection, rituximab 10 mg and hyaluronidase Inj rituximab, hyaluronidase51 A 2049 DYY20190101 O1D 1P 02019010120190101 A J9312001003Injection, rituximab, 10 mg Inj., rituximab, 10 mg 51 A 2049 DYY20190101 O1D 1P 02019010120190101 A 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 J9325001003Injection, talimogene laherparepvec, per 1 million plaque forming units Inj talimogene laherparepvec51 A CYY20170101 O1E 1 02017010120170101 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 J9351001003Injection, topotecan, 0.1 mg Topotecan injection 51 A C O1D 1P 02011010120180101 N J9352001003Injection, trabectedin, 0.1 mg Injection trabectedin 0.1mg 51 A CYY20170101 O1D 1 02017010120170101 N J9354001003Injection, ado-trastuzumab emtansine, 1 mg Inj, ado-trastuzumab emt 1mg51 A CYY20140101 O1D 1P 02014010120140101 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 J9371001003Injection, vincristine sulfate liposome, 1 mg Inj, vincristine sul lip 1mg51 A CYY20140101 O1D 1P 02014010120140101 N 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 J9400001003Injection, ziv-aflibercept, 1 mg Inj, ziv-aflibercept, 1mg 51 A CYY20140101 O1E 1 02014010120140101 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 K0001001003Standard 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 K0008001003Custom manual wheelchair/base Cstm manual wheelchair/base 45 A D 0188D1D APR 02013070120130701 N K0009001003Other manual wheelchair/base Other manual wheelchair/base36 A C D1D APR 01994010120130701 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 K0013001003Custom motorized/power wheelchair base Custom power whlchr base 45 A D 0188D1D APR 02013070120130701 N K0014001003Other motorized/power wheelchair base Other power whlchr base 36 A C D1D APR 01994010120010101 N K0015001003Detachable, non-adjustable height armrest, replacement only, each Detach non-adj ht armrst rep36 A C D1D APR 01994010120160701 N K0017001003Detachable, adjustable height armrest, base, replacement only, each Detach adjust armrest base 32 A C D1D APR 01994010120160101 N K0018001003Detachable, adjustable height armrest, upper portion, replacement only, each Detach adjust armrst upper 32 A C D1D APR 01994010120160101 N K0019001003Arm pad, replacement only, each Arm pad repl, each 32 A C D1D APR 01994010120170101 N K0020001003Fixed, adjustable height armrest, pair Fixed adjust armrest pair 32 A C D1D APR 01994010119940101 N K0037001003High mount flip-up footrest, each Hi mount flip-up footrest ea32 A C D1D APR 01994010120181001 C 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, replacement only, each Standard size ftplate rep ea32 A C D1D APR 01994010120170101 N K0043001003Footrest, lower extension tube, replacement only, each Ftrst lowr exten tube rep ea32 A C D1D APR 01994010120170101 N K0044001003Footrest, upper hanger bracket, replacement only, each Ftrst upr hanger brac rep ea32 A C D1D APR 01994010120170101 N K0045001003Footrest, complete assembly, replacement only, each Ftrst compl assembly repl ea32 A C D1D APR 01994010120170101 N K0046001003Elevating legrest, lower extension tube, replacement only, each Elev lgrst lwr exten repl ea32 A C D1D APR 01994010120170101 N K0047001003Elevating legrest, upper hanger bracket, replacement only, each Elev legrst upr hangr rep ea32 A C D1D APR 01994010120170101 N K0050001003Ratchet assembly, replacement only Ratchet assembly replacement32 A C D1D APR 01994010120170101 N K0051001003Cam release assembly, footrest or legrest, replacement only, each Cam rel asm ft/legrst rep ea32 A C D1D APR 01994010120170101 N K0052001003Swingaway, detachable footrests, replacement only, each Swingaway detach ftrest repl32 A C D1D APR 01994010120170101 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 strength, Seat ht <17 or >=21 ltwt wc 32 A C D1D APR 01994010119990101 N K0056002004lightweight, 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, replacement Rr whl compl sol tire rep ea32 A C D1D APR 01994010120170101 N K0069002004only, each K0070001003Rear wheel assembly, complete, with pneumatic tire, spokes or molded, Rr whl compl pne tire rep ea36 A C D1D APR 01994010120160701 N K0070002004replacement only, each K0071001003Front caster assembly, complete, with pneumatic tire, replacement only, each Fr cstr comp pne tire rep ea32 A C D1D APR 01994010120170101 N K0072001003Front caster assembly, complete, with semi-pneumatic tire, replacement only, Fr cstr semi-pne tire rep ea32 A C D1D APR 01994010120170101 N K0072002004each K0073001003Caster pin lock, each Caster pin lock each 32 A C D1D APR 01994010119940101 N K0077001003Front caster assembly, complete, with solid tire, replacement only, each Fr cstr asmb sol tire rep ea32 A C D1D APR 01994010120170101 N K0098001003Drive belt for power wheelchair, replacement only Drive belt for pwc, repl 32 A C D1D APR 01994010120170101 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 non-insulin drug infusion pump, syringe type cartridge, Sup/ext non-ins inf pump syr34 A60-14 D D1E P 02003070120170101 N K0552002004sterile, each K0553001003Supply allowance for therapeutic continuous glucose monitor (cgm), includes all Ther cgm supply allowance 34 A D 0212D1E 9 02017070120170701 N K0553002004supplies and accessories, 1 month supply = 1 unit of service K0554001003Receiver (monitor), dedicated, for use with therapeutic glucose continuous Ther cgm receiver/monitor 32 A D 0212D1E APR 02017070120170701 N K0554002004monitor system 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 36 A C D1E APR 02003070120140401 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 sys36 A C D1E R 02005070120140401 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) 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 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 00 9 C D1D APR 02006100120160101 N K0900001003Customized durable medical equipment, other than wheelchair Cstm dme other than wheelchr45 A D 0188D1E APR 02013070120130701 N K0901001003Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and Ko single upright pre ots 38 A L1851 C D1F P 0201410012017010120161231N K0901002004extension joint (unicentric or polycentric), medial-lateral and rotation K0901003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf K0902001003Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and Ko double upright pre ots 38 A L1852 C D1F P 0201410012017010120161231N K0902002004extension joint (unicentric or polycentric), medial-lateral and rotation K0902003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf K0903001003For diabetics only, multiple density insert, made by direct carving with cam Mult den insert dir carv/cam38 A C D1F J 0201804012019010120181231D K0903002004technology from a rectified cad model created from a digitized scan of the K0903003004patient, total contact with patient's foot, including arch, base layer minimum K0903004004of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler K0903005004and other shaping material, custom fabricated, each 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, prefabricated, off-the-shelf (foam collar) Cerv flex n/adj foam pre ots38 A C D1F P 01982010120140101 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, prefabricated, Cerv sr wire occ/man pre ots38 A C D1F P 01982010120140101 N L0160002004off-the-shelf 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, prefabricated, Cerv col sr foam 2pc pre ots38 A C D1F P 01988010120140101 N L0172002004off-the-shelf L0174001003Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic Cerv sr 2pc thor ext pre ots38 A C D1F P 01988010120140101 N L0174002004extension, prefabricated, off-the-shelf L0180001003Cervical, 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 L0220001003Thoracic, rib belt, custom fabricated Thor rib belt custom fabrica38 A C D1F P 01982010119960101 N L0450001003Tlso, flexible, provides trunk support, upper thoracic region, produces Tlso flex trunk/thor pre ots38 A C D1F P 02003010120140101 N L0450002004intracavitary pressure to reduce load on the intervertebral disks with rigid L0450003004stays or panel(s), includes shoulder straps and closures, prefabricated, L0450004004off-the-shelf 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 trnk sj-t9 pre cst 38 A C D1F P 02003010120140101 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 L0454005004item that has been trimmed, bent, molded, assembled, or otherwise customized to L0454006004fit a specific patient by an individual with expertise L0455001003Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to Tlso flex trnk sj-t9 pre ots38 A C D1F P 02014010120140101 N L0455002004above t-9 vertebra, restricts gross trunk motion in the sagittal plane, L0455003004produces intracavitary pressure to reduce load on the intervertebral disks with L0455004004rigid stays or panel(s), includes shoulder straps and closures, prefabricated, L0455005004off-the-shelf L0456001003Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel Tlso flex trnk sj-ss pre cst38 A C D1F P 02003010120140101 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 item that has L0456006004been trimmed, bent, molded, assembled, or otherwise customized to fit a L0456007004specific patient by an individual with expertise L0457001003Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel Tlso flex trnk sj-ss pre ots38 A C D1F P 02014010120140101 N L0457002004and soft anterior apron, extends from the sacrococcygeal junction and L0457003004terminates just inferior to the scapular spine, restricts gross trunk motion in L0457004004the sagittal plane, produces intracavitary pressure to reduce load on the L0457005004intervertebral disks, includes straps and closures, prefabricated, off-the-shelf 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 transverse 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 Tlso 2 shl symphys-stern cst38 A C D1F P 02003010120140101 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 L0460007004item that has been trimmed, bent, molded, assembled, or otherwise customized to L0460008004fit a specific patient by an individual with expertise 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 r fram soft ant pre cst38 A C D1F P 02003010120140101 N L0466002004with straps, closures and padding, restricts gross trunk motion in sagittal L0466003004plane, produces intracavitary pressure to reduce load on intervertebral disks, L0466004004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise L0466005004customized to fit a specific patient by an individual with expertise L0467001003Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron Tlso r fram soft pre ots 38 A C D1F P 02014010120140101 N L0467002004with straps, closures and padding, restricts gross trunk motion in sagittal L0467003004plane, produces intracavitary pressure to reduce load on intervertebral disks, L0467004004prefabricated, off-the-shelf L0468001003Tlso, sagittal-coronal control, rigid posterior frame and flexible soft Tlso rig fram pelvic pre cst38 A C D1F P 02003010120140101 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, L0468006004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise L0468007004customized to fit a specific patient by an individual with expertise L0469001003Tlso, sagittal-coronal control, rigid posterior frame and flexible soft Tlso rig fram pelvic pre ots38 A C D1F P 02014010120140101 N L0469002004anterior apron with straps, closures and padding, extends from sacrococcygeal L0469003004junction over scapulae, lateral strength provided by pelvic, thoracic, and L0469004004lateral frame pieces, restricts gross trunk motion in sagittal and coronal L0469005004planes, produces intracavitary pressure to reduce load on intervertebral disks, L0469006004prefabricated, off-the-shelf 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 pelvic/sacr pre ots38 A C D1F P 02006010120140101 N L0621002004about the sacroiliac joint, includes straps, closures, may include pendulous L0621003004abdomen design, prefabricated, off-the-shelf 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 rig pnl pelv/sac pre ots38 A C D1F P 02006010120140101 N L0623002004panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, L0623003004includes straps, closures, may include pendulous abdomen design, prefabricated, L0623004004off-the-shelf 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 flex l1-below l5 pre ots 38 A C D1F P 02006010120140101 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, off-the-shelf L0626001003Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior Lo sag rig pnl stays pre cst38 A C D1F P 02006010120140101 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 item L0626005004that has been trimmed, bent, molded, assembled, or otherwise customized to fit L0626006004a specific patient by an individual with expertise L0627001003Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, Lo sag ri an/pos pnl pre cst38 A C D1F P 02006010120140101 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 L0627005004item that has been trimmed, bent, molded, assembled, or otherwise customized to L0627006004fit a specific patient by an individual with expertise L0628001003Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior Lso flex no ri stays pre ots38 A C D1F P 02006010120140101 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, L0628005004off-the-shelf 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 r post pnl sj-t9 pre cst38 A C D1F P 02006010120140101 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 item that has been trimmed, bent, molded, L0630006004assembled, or otherwise customized to fit a specific patient by an individual L0630007004with expertise L0631001003Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior Lso sag r an/pos pnl pre cst38 A C D1F P 02006010120140101 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 item that has been trimmed, bent, molded, L0631006004assembled, or otherwise customized to fit a specific patient by an individual L0631007004with expertise 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 sc r pos/lat pnl pre cst38 A C D1F P 02006010120140101 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 item that has been trimmed, bent, molded, assembled, or otherwise L0633007004customized to fit a specific patient by an individual with expertise 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 sc r ant/pos pnl pre cst38 A C D1F P 02006010120140101 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 item that has been trimmed, bent, molded, assembled, or otherwise L0637007004customized to fit a specific patient by an individual with expertise 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 02006010120140101 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 item that L0639007004has been trimmed, bent, molded, assembled, or otherwise customized to fit a L0639008004specific patient by an individual with expertise 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 L0641001003Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior Lo rig pos pnl l1-l5 pre ots38 A C D1F P 02014010120140101 N L0641002004extends from l-1 to below l-5 vertebra, produces intracavitary pressure to L0641003004reduce load on the intervertebral discs, includes straps, closures, may include L0641004004padding, stays, shoulder straps, pendulous abdomen design, prefabricated, L0641005004off-the-shelf L0642001003Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, Lo sag ri an/pos pnl pre ots38 A C D1F P 02014010120140101 N L0642002004posterior extends from l-1 to below l-5 vertebra, produces intracavitary L0642003004pressure to reduce load on the intervertebral discs, includes straps, closures, L0642004004may include padding, shoulder straps, pendulous abdomen design, prefabricated, L0642005004off-the-shelf L0643001003Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), Lso sag ctr rigi pos pre ots38 A C D1F P 02014010120140101 N L0643002004posterior extends from sacrococcygeal junction to t-9 vertebra, produces L0643003004intracavitary pressure to reduce load on the intervertebral discs, includes L0643004004straps, closures, may include padding, stays, shoulder straps, pendulous L0643005004abdomen design, prefabricated, off-the-shelf L0648001003Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior Lso sag r an/pos pnl pre ots38 A C D1F P 02014010120140101 N L0648002004panels, posterior extends from sacrococcygeal junction to t-9 vertebra, L0648003004produces intracavitary pressure to reduce load on the intervertebral discs, L0648004004includes straps, closures, may include padding, shoulder straps, pendulous L0648005004abdomen design, prefabricated, off-the-shelf L0649001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior Lso sc r pos/lat pnl pre ots38 A C D1F P 02014010120140101 N L0649002004frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, L0649003004lateral strength provided by rigid lateral frame/panels, produces intracavitary L0649004004pressure to reduce load on intervertebral discs, includes straps, closures, may L0649005004include padding, stays, shoulder straps, pendulous abdomen design, L0649006004prefabricated, off-the-shelf L0650001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and Lso sc r ant/pos pnl pre ots38 A C D1F P 02014010120140101 N L0650002004posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 L0650003004vertebra, lateral strength provided by rigid lateral frame/panel(s), produces L0650004004intracavitary pressure to reduce load on intervertebral discs, includes straps, L0650005004closures, may include padding, shoulder straps, pendulous abdomen design, L0650006004prefabricated, off-the-shelf L0651001003Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), Lso sag-co shell pnl pre ots38 A C D1F P 02014010120140101 N L0651002004posterior extends from sacrococcygeal junction to t-9 vertebra, anterior L0651003004extends from symphysis pubis to xyphoid, produces intracavitary pressure to L0651004004reduce load on the intervertebral discs, overall strength is provided by L0651005004overlapping rigid material and stabilizing closures, includes straps, closures, L0651006004may include soft interface, pendulous abdomen design, prefabricated, L0651007004off-the-shelf L0700001003Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral Ctlso a-p-l control molded 38 A C D1F P 01984010119960101 N L0700002004control, 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) L0810001003Halo procedure, cervical halo incorporated into jacket vest Halo cervical into jckt vest38 A C D1F P 01986010119860101 N L0820001003Halo procedure, cervical halo incorporated into plaster body jacket Halo cervical into body jack38 A C D1F P 01986010119860101 N L0830001003Halo procedure, cervical halo incorporated into milwaukee type orthosis Halo cerv into milwaukee typ38 A C D1F P 01986010119860101 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 L0970001003Tlso, 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, prefabricated, off-the-shelf, pair Peroneal straps pair pre ots38 A C D1F P 01986010120140101 N L0982001003Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) Stocking sup grips 4 pre ots38 A C D1F P 01982010120140101 N L0984001003Protective body sock, prefabricated, off-the-shelf, each Protect body sock ea pre ots38 A C D1F P 01994010120140101 N L0999001003Addition to spinal orthosis, not otherwise specified Add to spinal orthosis nos 46 A C D1F P 01998010119980101 N L1000001003Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of Ctlso milwauke initial model38 A C D1F P 01986010119960101 N L1000002004furnishing 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 L1010001003Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis Ctlso axilla sling 38 A C D1F P 01986010119960101 N L1010002004orthosis, 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 01986010119860101 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 L1200001003Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial Furnsh initial orthosis only38 A C D1F P 01986010119960101 N L1200002004orthosis 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 L1300001003Other 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 01986010119860101 N L1499001003Spinal orthosis, not otherwise specified Spinal orthosis nos 46 A C D1F P 01982010119980101 N L1600001003Hip orthosis, abduction control of hip joints, flexible, frejka type with Ho flex frejka w/cov pre cst38 A C D1F P 01986010120140101 N L1600002004cover, prefabricated item that has been trimmed, bent, molded, assembled, or L1600003004otherwise customized to fit a specific patient by an inidividual with expertise L1610001003Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), Ho frejka cov only pre cst 38 A C D1F P 01982010120140101 N L1610002004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise L1610003004customized to fit a specific patient by an individual with expertise L1620001003Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), Ho flex pavlik harns pre cst38 A C D1F P 01982010120140101 N L1620002004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise L1620003004customized to fit a specific patient by an individual with expertise 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 L1700001003Legg 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 L1810001003Knee orthosis, elastic with joints, prefabricated item that has been trimmed, Ko elastic with joints 38 A C D1F P 01982010120140101 N L1810002004bent, molded, assembled, or otherwise customized to fit a specific patient by L1810003004an individual with expertise L1812001003Knee orthosis, elastic with joints, prefabricated, off-the-shelf Ko elastic w/joints pre ots 38 A C D1F P 02014010120140101 N 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 L1830001003Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf Ko immob canvas long pre ots38 A C D1F P 01986010120140101 N 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 r sup pre cst38 A C D1F P 01989010120140101 N L1832002004orthosis, rigid support, prefabricated item that has been trimmed, bent, L1832003004molded, assembled, or otherwise customized to fit a specific patient by an L1832004004individual with expertise L1833001003Knee orthosis, adjustable knee joints (unicentric or polycentric), positional Ko adj jnt pos r sup pre ots38 A C D1F P 02014010120140101 N L1833002004orthosis, rigid support, prefabricated, off-the shelf 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, Ko rigid w/o joints pre ots 38 A C D1F P 02003010120140101 N L1836002004prefabricated, off-the-shelf 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 pre cst 38 A C D1F P 01998010120140101 N L1843002004extension joint (unicentric or polycentric), medial-lateral and rotation L1843003004control, with or without varus/valgus adjustment, prefabricated item that has L1843004004been trimmed, bent, molded, assembled, or otherwise customized to fit a L1843005004specific patient by an individual with expertise 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 double upright pre cst 38 A C D1F P 01988010120140101 N L1845002004extension joint (unicentric or polycentric), medial-lateral and rotation L1845003004control, with or without varus/valgus adjustment, prefabricated item that has L1845004004been trimmed, bent, molded, assembled, or otherwise customized to fit a L1845005004specific patient by an individual with expertise 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 dbl upright w/air pre cst38 A C D1F P 01999010120140101 N L1847002004support chamber(s), prefabricated item that has been trimmed, bent, molded, L1847003004assembled, or otherwise customized to fit a specific patient by an individual L1847004004with expertise L1848001003Knee orthosis, double upright with adjustable joint, with inflatable air Ko dbl upright w/air pre ots38 A C D1F P 02014010120140101 N L1848002004support chamber(s), prefabricated, off-the-shelf L1850001003Knee orthosis, swedish type, prefabricated, off-the-shelf Ko swedish type pre ots 38 A C D1F P 01982010120140101 N L1851001003Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and Ko single upright prefab ots38 A C D1F P 02017010120170101 N L1851002004extension joint (unicentric or polycentric), medial-lateral and rotation L1851003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf L1852001003Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and Ko double upright prefab ots38 A C D1F P 02017010120170101 N L1852002004extension joint (unicentric or polycentric), medial-lateral and rotation L1852003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf L1860001003Knee orthosis, modification of supracondylar prosthetic socket, custom Ko supracondylar socket mold38 A C D1F P 01982010120010101 N L1860002004fabricated (sk) L1900001003Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom Afo sprng wir drsflx calf bd38 A C D1F P 01986010120010101 N L1900002004fabricated L1902001003Ankle orthosis, ankle gauntlet or similar, with or without joints, Afo ankle gauntlet pre ots 38 A C D1F P 01988010120160101 N L1902002004prefabricated, off-the-shelf L1904001003Ankle orthosis, ankle gauntlet or similar, with or without joints, custom Afo molded ankle gauntlet 38 A C D1F P 01988010120160101 N L1904002004fabricated L1906001003Ankle foot orthosis, multiligamentous ankle support, prefabricated, Afo multilig ank sup pre ots38 A C D1F P 01988010120170101 N L1906002004off-the-shelf L1907001003Ankle orthosis, supramalleolar with straps, with or without interface/pads, Afo supramalleolar custom 38 A C D1F P 02004010120140101 N L1907002004custom fabricated 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 L2000001003Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, Kafo sing fre stirr thi/calf38 A C D1F P 01985010120010101 N L2000002004thigh 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, custom L2010003004fabricated 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 L2040001003Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, Hkafo torsion bil rot straps38 A C D1F P 01986010120010101 N L2040002004pelvic 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, custom Afo tib fx cast molded to pt38 A C D1F P 01988010120010101 N L2108002004fabricated 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 L2180001003Addition to lower extremity fracture orthosis, plastic shoe insert with ankle Plas shoe insert w ank joint38 A C D1F P 01988010119960101 N L2180002004joints 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 L2200001003Addition 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 01986010119860101 N L2250002004attachment L2260001003Addition to lower extremity, reinforced solid stirrup (scott-craig type) Reinforced solid stirrup 38 A C D1F P 01986010119860101 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 01986010119860101 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 01986010119860101 N L2300001003Addition to lower extremity, abduction bar (bilateral hip involvement), Abduction bar jointed adjust38 A C D1F P 01986010119860101 N L2300002004jointed, adjustable L2310001003Addition to lower extremity, abduction bar-straight Abduction bar-straight 38 A C D1F P 01986010119860101 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 01988010119880101 N L2340001003Addition to lower extremity, pre-tibial shell, molded to patient model Pre-tibial shell molded to p38 A C D1F P 01986010119860101 N L2350001003Addition to lower extremity, prosthetic type, (bk) socket, molded to patient Prosthetic type socket molde38 A C D1F P 01986010119860101 N L2350002004model, (used for 'ptb' 'afo' orthoses) L2360001003Addition to lower extremity, extended steel shank Extended steel shank 38 A C D1F P 01986010119860101 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 stirrupTorsion ank & half solid sti38 A C D1F P 01988010119880101 N L2380001003Addition to lower extremity, torsion control, straight knee joint, each joint Torsion straight knee joint 38 A C D1F P 01988010119880101 N L2385001003Addition to lower extremity, straight knee joint, heavy duty, each joint Straight knee joint heavy du38 A C D1F P 01988010119880101 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 01988010119880101 N L2395001003Addition to lower extremity, offset knee joint, heavy duty, each joint Offset knee joint heavy duty38 A C D1F P 01988010119880101 N L2397001003Addition to lower extremity orthosis, suspension sleeve Suspension sleeve lower ext 38 A C D1F P 01994010119960101 N L2405001003Addition 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 L2500001003Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight Thi/glut/ischia wgt bearing 38 A C D1F P 01986010119960101 N L2500002004bearing, 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, custom Th/wght bear quad-lat brim c38 A C D1F P 01986010119860101 N L2520002004fitted 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 01986010119860101 N L2540001003Addition to lower extremity, thigh/weight bearing, lacer, molded to patient Thigh/wght bear lacer molded38 A C D1F P 01986010119860101 N L2540002004model L2550001003Addition to lower extremity, thigh/weight bearing, high roll cuff Thigh/wght bear high roll cu38 A C D1F P 01986010119860101 N L2570001003Addition to lower extremity, pelvic control, hip joint, clevis type two Hip clevis type 2 posit jnt 38 A C D1F P 01986010119960101 N L2570002004position 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 L2750001003Addition 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 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 L3000001003Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, Ft insert ucb berkeley shell00 9 2323 D D1F P 01982010119970101 N L3000002004each 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 L3040001003Foot, 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 L3070001003Foot, 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, prefabricated, off-the-shelf Hallus-valgus nt dyn pre ots00 9 2323 D D1F P 01985010120140101 N L3140001003Foot, abduction rotation bar, including shoes Abduction rotation bar shoe 00 9 2323 D D1F P 01982010119970101 N L3150001003Foot, abduction rotation 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, prefabricated, Foot plas heel stabi pre ots00 9 2323 D D1F P 01984010120140101 N L3170002004off-the-shelf, each L3201001003Orthopedic 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 L3300001003Lift, 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 L3340001003Heel 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 L3430001003Heel, 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 L3500001003Orthopedic 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 L3600001003Transfer 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 L3650001003Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, So 8 abd restraint pre ots 38 A C D1F P 01986010120140101 N L3650002004off-the-shelf L3660001003Shoulder orthosis, figure of eight design abduction restrainer, canvas and So 8 ab rstr can/web pre ots38 A C D1F P 01982010120140101 N L3660002004webbing, prefabricated, off-the-shelf L3670001003Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, So acro/clav can web pre ots38 A C D1F P 01982010120140101 N L3670002004off-the-shelf 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 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 So vest canvas/web pre ots 38 A C D1F P 01999010120140101 N L3675002004equal, prefabricated, off-the-shelf L3677001003Shoulder orthosis, shoulder joint design, without joints, may include soft So hard plas stabili pre cst00 9 2130 D Z2 P 02002010120140101 N L3677002004interface, straps, prefabricated item that has been trimmed, bent, molded, L3677003004assembled, or otherwise customized to fit a specific patient by an individual L3677004004with expertise L3678001003Shoulder orthosis, shoulder joint design, without joints, may include soft So hard plas stabili pre ots38 A C D1F P 02014010120140101 N L3678002004interface, straps, prefabricated, off-the-shelf 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, off-the-shelf Eo elas w/metal jnts pre ots38 A C D1F P 01986010120140101 N L3720001003Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom Forearm/arm cuffs free motio38 A C D1F P 01984010120010101 N L3720002004fabricated 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 (eo), with adjustable position locking joint(s), prefabricated, Eo adj jt prefab custom fit 38 A C D1F P 02001010120180101 N L3760002004item that has been trimmed, bent, molded, assembled, or otherwise customized to L3760003004fit a specific patient by an individual with expertise L3761001003Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, Eo, adj lock joint prefab ot38 A C D1F P 02018010120180101 N L3761002004off-the-shelf L3762001003Elbow orthosis, rigid, without joints, includes soft interface material, Eo rigid w/o joints pre ots 38 A C D1F P 02003010120140101 N L3762002004prefabricated, off-the-shelf 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 item that has been Whfo w/o joints pre cst 38 A C D1F P 02000010120140101 N L3807002004trimmed, bent, molded, assembled, or otherwise customized to fit a specific L3807003004patient by an individual with expertise 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 L3809001003Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any Whfo w/o joints pre ots 38 A C D1F P 02014010120140101 N L3809002004type 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 L3906001003Wrist hand orthosis, without joints, may include soft interface, straps, custom Who w/o joints cf 38 A C D1F P 01986010120060101 N L3906002004fabricated, includes fitting and adjustment L3908001003Wrist hand orthosis, wrist extension control cock-up, non molded, Who cock-up nonmolde pre ots38 A C D1F P 01986010120140101 N L3908002004prefabricated, off-the-shelf L3912001003Hand finger orthosis (hfo), flexion glove with elastic finger control, Hfo flexion glove pre ots 38 A C D1F P 01982010120140101 N L3912002004prefabricated, off-the-shelf 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 nontorsion jnts pre cst 38 A C D1F P 02007010120140101 N L3915002004turnbuckles, may include soft interface, straps, prefabricated item that has L3915003004been trimmed, bent, molded, assembled, or otherwise customized to fit a L3915004004specific patient by an individual with expertise L3916001003Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, Who nontorsion jnts pre ots 38 A C D1F P 02014010120140101 N L3916002004turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf L3917001003Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been Metacarp fx orthosis pre cst38 A C D1F P 02004010120140101 N L3917002004trimmed, bent, molded, assembled, or otherwise customized to fit a specific L3917003004patient by an individual with expertise L3918001003Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf Metacarp fx orthosis pre ots38 A C D1F P 02014010120140101 N 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 without joints pre cst 38 A C D1F P 02001010120140101 N L3923002004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise L3923003004customized to fit a specific patient by an individual with expertise L3924001003Hand finger orthosis, without joints, may include soft interface, straps, Hfo without joints pre ots 38 A C D1F P 02014010120140101 N L3924002004prefabricated, off-the-shelf L3925001003Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), Fo pip dip jnt/sprng pre ots38 A C D1F P 02008010120140101 N L3925002004non torsion joint/spring, extension/flexion, may include soft interface L3925003004material, prefabricated, off-the-shelf L3927001003Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), Fo pip dip no jt spr pre ots38 A C D1F P 02008010120140101 N L3927002004without joint/spring, extension/flexion (e.g., static or ring type), may L3927003004include soft interface material, prefabricated, off-the-shelf L3929001003Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, Hfo nontorsion jnts pre cst 38 A C D1F P 02008010120140101 N L3929002004elastic bands/springs, may include soft interface material, straps, L3929003004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise L3929004004customized to fit a specific patient by an individual with expertise L3930001003Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, Hfo nontorsion jnts pre ots 38 A C D1F P 02014010120140101 N L3930002004elastic bands/springs, may include soft interface material, straps, L3930003004prefabricated, off-the-shelf 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 L3960001003Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, Sewho airplan desig abdu pos38 A C D1F P 01986010120010101 N L3960002004prefabricated, 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, erb's palsey design, Sewho erbs palsey design abd38 A C D1F P 01982010120010101 N L3962002004prefabricated, 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 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 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 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 L3980001003Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and Up ext fx orthos humeral nos38 A C D1F P 01982010120150101 N L3980002004adjustment L3981001003Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder Ue fx orth shoul cap forearm38 A C D1F P 02015010120150101 N L3981002004cap design, with or without joints, forearm section, may include soft L3981003004interface, straps, includes fitting and adjustments 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 L4000001003Replace 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 Ankle control ortho pre ots 38 A C D1F P 01989010120140101 N L4350002004(e.g., pneumatic, gel), prefabricated, off-the-shelf L4360001003Walking boot, pneumatic and/or vacuum, with or without joints, with or without Pneumat walking boot pre cst38 A C D1F P 01989010120140101 N L4360002004interface material, prefabricated item that has been trimmed, bent, molded, L4360003004assembled, or otherwise customized to fit a specific patient by an individual L4360004004with expertise L4361001003Walking boot, pneumatic and/or vacuum, with or without joints, with or without Pneuma/vac walk boot pre ots38 A C D1F P 02014010120140101 N L4361002004interface material, prefabricated, off-the-shelf L4370001003Pneumatic full leg splint, prefabricated, off-the-shelf Pneum full leg splnt pre ots38 A C D1F P 01989010120140101 N L4386001003Walking boot, non-pneumatic, with or without joints, with or without interface Non-pneum walk boot pre cst 38 A C D1F P 02003010120140101 N L4386002004material, prefabricated item that has been trimmed, bent, molded, assembled, or L4386003004otherwise customized to fit a specific patient by an individual with expertise L4387001003Walking boot, non-pneumatic, with or without joints, with or without interface Non-pneum walk boot pre ots 38 A C D1F P 02014010120140101 N L4387002004material, prefabricated, off-the-shelf 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 or dynami afo pre cst38 A C D1F P 01997010120140101 N L4396002004adjustable for fit, for positioning, may be used for minimal ambulation, L4396003004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise L4396004004customized to fit a specific patient by an individual with expertise L4397001003Static or dynamic ankle foot orthosis, including soft interface material, Static or dynami afo pre ots38 A C D1F P 02014010120140101 N L4397002004adjustable for fit, for positioning, may be used for minimal ambulation, L4397003004prefabricated, off-the-shelf L4398001003Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf Foot drop splint pre ots 38 A C D1F P 01997010120140101 N 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 L5000001003Partial 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 L5050001003Ankle, 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 L5100001003Below 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 L5150001003Knee disarticulation (or through knee), molded socket, external knee joints, Mold sckt ext knee shin sach38 A C D1F P 01982010119960101 N L5150002004shin, 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 L5200001003Above 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 L5250001003Hip disarticulation, canadian type; molded socket, hip joint, single axis Hip canad sing axi cons fric38 A C D1F P 01982010119960101 N L5250002004constant 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 L5280001003Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant Hemipelvect canad sing axis 38 A C D1F P 01982010119960101 N L5280002004friction 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 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 L5400001003Immediate post surgical or early fitting, application of initial rigid Postop dress & 1 cast chg bk38 A C D1F P 01982010119960101 N L5400002004dressing, including fitting, alignment, suspension, and one cast change, below L5400003004knee 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 L5500001003Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, Init bk ptb plaster direct 38 A C D1F P 01986010119960101 N L5500002004sach 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 L5510001003Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no Prep bk ptb plaster molded 38 A C D1F P 01986010119960101 N L5510002004cover, 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 L5600001003Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, Hip disart sach laminat mold38 A C D1F P 01989010119960101 N L5600002004laminated 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 L5618001003Addition 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 L5630001003Addition 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 01986010119860101 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 01986010119860101 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 01986010119860101 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 01986010119860101 N L5642001003Addition to lower extremity, above knee, leather socket Above knee leather socket 38 A C D1F P 01986010119860101 N L5643001003Addition to lower extremity, hip disarticulation, flexible inner socket, Hip flex inner socket ext fr38 A C D1F P 01988010119880101 N L5643002004external frame L5644001003Addition to lower extremity, above knee, wood socket Above knee wood socket 38 A C D1F P 01986010119860101 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 01988010119880101 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 01988010119880101 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 01988010119880101 N L5652001003Addition to lower extremity, suction suspension, above knee or knee Suction susp ak/knee disart 38 A C D1F P 01986010119860101 N L5652002004disarticulation socket L5653001003Addition to lower extremity, knee disarticulation, expandable wall socket Knee disart expand wall sock38 A C D1F P 01986010119860101 N L5654001003Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, Socket insert symes 38 A C D1F P 01986010119860101 N L5654002004plastazote or equal) L5655001003Addition to lower extremity, socket insert, below knee (kemblo, pelite, Socket insert below knee 38 A C D1F P 01986010119860101 N L5655002004aliplast, plastazote or equal) L5656001003Addition to lower extremity, socket insert, knee disarticulation (kemblo, Socket insert knee articulat38 A C D1F P 01986010119860101 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 01986010119860101 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 Bk molded distal cushion 38 A C D1F P 01986010120140101 N L5670001003Addition to lower extremity, below knee, molded supracondylar suspension ('pts' Bk molded supracondylar susp38 A C D1F P 01986010119860101 N L5670002004or 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 01986010119860101 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 01986010119860101 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 01986010119860101 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 01986010119860101 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 01986010119860101 N L5688001003Addition to lower extremity, below knee, waist belt, webbing Bk waist belt webbing 38 A C D1F P 01986010119860101 N L5690001003Addition to lower extremity, below knee, waist belt, padded and lined Bk waist belt padded and lin38 A C D1F P 01986010119860101 N L5692001003Addition to lower extremity, above knee, pelvic control belt, light Ak pelvic control belt light38 A C D1F P 01986010119860101 N L5694001003Addition to lower extremity, above knee, pelvic control belt, padded and lined Ak pelvic control belt pad/l38 A C D1F P 01986010119860101 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 01986010119860101 N L5697001003Addition to lower extremity, above knee or knee disarticulation, pelvic band Ak/knee disartic pelvic band38 A C D1F P 01986010119860101 N L5698001003Addition to lower extremity, above knee or knee disarticulation, silesian Ak/knee disartic silesian ba38 A C D1F P 01986010119860101 N L5698002004bandage L5699001003All lower extremity prostheses, shoulder harness Shoulder harness 38 A C D1F P 01986010119960101 N L5700001003Replacement, 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 L5710001003Addition, exoskeletal knee-shin system, single axis, manual lock Kne-shin exo sng axi mnl loc38 A C D1F P 01986010119860101 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 01986010119860101 N L5712002004phase control (safety knee) L5714001003Addition, exoskeletal knee-shin system, single axis, variable friction swing Knee-shin exo variable frict38 A C D1F P 01986010119860101 N L5714002004phase control L5716001003Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase Knee-shin exo mech stance ph38 A C D1F P 01986010119860101 N L5716002004lock L5718001003Addition, exoskeletal knee-shin system, polycentric, friction swing and stance Knee-shin exo frct swg & sta38 A C D1F P 01986010119860101 N L5718002004phase control L5722001003Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction Knee-shin pneum swg frct exo38 A C D1F P 01986010119860101 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 01986010119860101 N L5726001003Addition, exoskeletal knee-shin system, single axis, external joints fluid Knee-shin ext jnts fld swg e38 A C D1F P 01986010119860101 N L5726002004swing phase control L5728001003Addition, exoskeletal knee-shin system, single axis, fluid swing and stance Knee-shin fluid swg & stance38 A C D1F P 01986010119860101 N L5728002004phase control L5780001003Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic Knee-shin pneum/hydra pneum 38 A C D1F P 01986010119860101 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 L5785001003Addition, exoskeletal system, below knee, ultra-light material (titanium, Exoskeletal bk ultralt mater38 A C D1F P 01988010119960101 N L5785002004carbon 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) L5810001003Addition, 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 01988010119880101 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 N 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 01988010119880101 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 01988010119880101 N L5940002004carbon fiber or equal) L5950001003Addition, endoskeletal system, above knee, ultra-light material (titanium, Endo ak ultra-light material38 A C D1F P 01988010119880101 N L5950002004carbon fiber or equal) L5960001003Addition, endoskeletal system, hip disarticulation, ultra-light material Endo hip ultra-light materia38 A C D1F P 01988010119880101 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 L5969001003Addition, endoskeletal ankle-foot or ankle system, power assist, includes any Ak/ft power asst incl motors38 A C D1F P 02014010120140101 N L5969002004type motor(s) 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 N 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 L6000001003Partial 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 0200301012015010120141231N L6025002004power, self-suspended, inner socket with removable forearm section, electrodes L6025003004and cables, two batteries, charger, myoelectric control of terminal device L6026001003Transcarpal/metacarpal or partial hand disarticulation prosthesis, external Part hand myo exclu term dev38 A C D1F P 02015010120150101 N L6026002004power, self-suspended, inner socket with removable forearm section, electrodes L6026003004and cables, two batteries, charger, myoelectric control of terminal device, L6026004004excludes terminal device(s) L6050001003Wrist 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 L6100001003Below 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 L6200001003Elbow 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 L6250001003Above elbow, molded double wall socket, internal locking elbow, forearm Elbow inter loc elbow forarm38 A C D1F P 01982010119960101 N L6300001003Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, Shlder disart int lock elbow38 A C D1F P 01982010119960101 N L6300002004internal 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 L6350001003Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, Thoracic intern lock elbow 38 A C D1F P 01984010119960101 N L6350002004internal 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 L6380001003Immediate post surgical or early fitting, application of initial rigid Postop dsg cast chg wrst/elb38 A C D1F P 01988010119960101 N L6380002004dressing, including fitting alignment and suspension of components, and one L6380003004cast 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 L6400001003Below elbow, molded socket, endoskeletal system, including soft prosthetic Below elbow prosth tiss shap38 A C D1F P 01982010119960101 N L6400002004tissue shaping L6450001003Elbow disarticulation, molded socket, endoskeletal system, including soft Elb disart prosth tiss shap 38 A C D1F P 01982010119960101 N L6450002004prosthetic tissue shaping L6500001003Above elbow, molded socket, endoskeletal system, including soft prosthetic Above elbow prosth tiss shap38 A C D1F P 01982010119960101 N L6500002004tissue shaping L6550001003Shoulder disarticulation, molded socket, endoskeletal system, including soft Shldr disar prosth tiss shap38 A C D1F P 01984010119960101 N L6550002004prosthetic tissue shaping L6570001003Interscapular thoracic, molded socket, endoskeletal system, including soft Scap thorac prosth tiss shap38 A C D1F P 01984010119960101 N L6570002004prosthetic 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 L6600001003Upper 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 01986010119860101 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 frictionFlexion/extension wrist unit38 A C D1F P 01986010120040101 N 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 01988010119880101 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 01986010119860101 N L6628001003Upper extremity addition, quick disconnect hook adapter, otto bock or equal Quick disconn hook adapter o38 A C D1F P 01988010119880101 N L6629001003Upper extremity addition, quick disconnect lamination collar with coupling Lamination collar w/ couplin38 A C D1F P 01988010119880101 N L6629002004piece, otto bock or equal L6630001003Upper extremity addition, stainless steel, any wrist Stainless steel any wrist 38 A C D1F P 01986010119860101 N L6632001003Upper extremity addition, latex suspension sleeve, each Latex suspension sleeve each38 A C D1F P 01988010119880101 N L6635001003Upper extremity addition, lift assist for elbow Lift assist for elbow 38 A C D1F P 01986010119860101 N L6637001003Upper extremity addition, nudge control elbow lock Nudge control elbow lock 38 A C D1F P 01988010119880101 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 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 01988010119880101 N L6642001003Upper extremity addition, excursion amplifier, lever type Excursion amplifier lever ty38 A C D1F P 01988010119880101 N L6645001003Upper extremity addition, shoulder flexion-abduction joint, each Shoulder flexion-abduction j38 A C D1F P 01986010119860101 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 01986010119860101 N L6655001003Upper extremity addition, standard control cable, extra Standard control cable extra38 A C D1F P 01986010119860101 N L6660001003Upper extremity addition, heavy duty control cable Heavy duty control cable 38 A C D1F P 01986010119860101 N L6665001003Upper extremity addition, teflon, or equal, cable lining Teflon or equal cable lining38 A C D1F P 01986010119860101 N L6670001003Upper extremity addition, hook to hand, cable adapter Hook to hand cable adapter 38 A C D1F P 01986010119860101 N L6672001003Upper extremity addition, harness, chest or shoulder, saddle type Harness chest/shlder saddle 38 A C D1F P 01986010119860101 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 01986010119860101 N L6682001003Upper extremity addition, test socket, elbow disarticulation or above elbow Test sock elbw disart/above 38 A C D1F P 01986010119860101 N L6684001003Upper extremity addition, test socket, shoulder disarticulation or Test socket shldr disart/tho38 A C D1F P 01986010119860101 N L6684002004interscapular thoracic L6686001003Upper extremity addition, suction socket Suction socket 38 A C D1F P 01988010119880101 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 01988010119880101 N L6690001003Upper extremity addition, frame type socket, interscapular-thoracic Frame typ sock interscap-tho38 A C D1F P 01988010119880101 N L6691001003Upper extremity addition, removable insert, each Removable insert each 38 A C D1F P 01988010119880101 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 myoelectric 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 L6890001003Addition to upper extremity prosthesis, glove for terminal device, any Prefab glove for term device38 A C D1F P 01986010120050101 N L6890002004material, 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 L6900001003Hand restoration (casts, shading and measurements included), partial hand, with Hand restorat thumb/1 finger38 A C D1F P 01982010119960101 N L6900002004glove, 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 L6920001003Wrist disarticulation, external power, self-suspended inner socket, removable Wrist disarticul switch ctrl38 A C D1F P 01988010119960101 N L6920002004forearm shell, otto bock or equal, switch, cables, two batteries and one L6920003004charger, 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 L7259001003Electronic wrist rotator, any type Electronic wrist rotator any38 A C D1F P 02015010120150101 N L7260001003Electronic wrist rotator, otto bock or equal Electron wrist rotator otto 38 A L7259 C D1F P 0198801012015010120141231N L7261001003Electronic wrist rotator, for utah arm Electron wrist rotator utah 38 A L7259 C D1F P 0198801012015010120141231N L7360001003Six 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, rechargeable, replacement Replacemnt lithium ionbatter38 A C D1F P 02003010120150101 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 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 L7700001003Gasket or seal, for use with prosthetic socket insert, any type, each Pros soc insert gasket/seal 38 A C D1F P 02018010120180101 N L7900001003Male vacuum erection system Male vacuum erection system 00 9 1834a S D1F P 01997010120160101 N L7902001003Tension ring, for vacuum erection device, any type, replacement only, each Tension ring, vac erect dev 00 9 1834a S D1F P 02013010120160101 N L8000001003Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, Mastectomy bra 38 A 2130 A D D1F P 01986010120130101 N L8000002004any size, any type L8001001003Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, Breast prosthesis bra & form38 A 2130A D D1F P 02002010120130101 N 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 N 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 L8300001003Truss, 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 L8400001003Prosthetic 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 L8600001003Implantable 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 N 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 L8607001003Injectable bulking agent for vocal cord medialization, 0.1 ml, includes Inj vocal cord bulking agent38 A 65.9 D D1F P 02016010120160101 N L8607002004shipping and necessary supplies L8608001003Miscellaneous external component, supply or accessory for use with the argus ii Arg ii ext com/sup/acc misc 46 A C D1F P 02019010120190101 A L8608002004retinal prosthesis system L8609001003Artificial cornea Artificial cornea 38 A C D1F P 02006010120060101 N L8610001003Ocular 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 or auditory Coch implant tran cable repl38 A65-14 D D1F P 02005010120180101 N L8618002004osseointegrated device, replacement 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 and auditory Repl zinc air battery 38 A C D1F P 02005010120160101 N L8621002004osseointegrated sound processors, replacement, each 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 or auditory osseointegrated Lith ion batt cid, ear level38 A C D1F P 02006010120180101 N L8624002004device speech processor, ear level, replacement, each L8625001003External recharging system for battery for use with cochlear implant or Charger coch impl/aoi battry38 A65-14 D D1F P 02018010120180101 N L8625002004auditory osseointegrated device, replacement only, 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) for L8659003004surgical implantation, any size L8670001003Vascular graft material, synthetic, implant Vascular graft, synthetic 38 A 2130 D D1F P 01992010119971001 N L8679001003Implantable neurostimulator, pulse generator, any type Imp neurosti pls gn any type38 A65-8 D D1F P 02014010120140101 N L8680001003Implantable neurostimulator electrode, each Implt neurostim elctr each 00 9 I D1F P 02006010120140401 N 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 38 A65-8 D D1F P 02006010120060101 N L8683001003Radiofrequency transmitter (external) for use with implantable neurostimulator Radiofq trsmtr for implt neu38 A65-8 D D1F P 02006010120060101 N L8683002004radiofrequency receiver L8684001003Radiofrequency transmitter (external) for use with implantable sacral root Radiof trsmtr implt scrl neu38 A65-8 D D1F P 02006010120060101 N 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 02006010120140101 N L8685002004includes extension L8686001003Implantable neurostimulator pulse generator, single array, non-rechargeable, Implt nrostm pls gen sng non00 9 I D1F P 02006010120140101 N L8686002004includes extension L8687001003Implantable neurostimulator pulse generator, dual array, rechargeable, includes Implt nrostm pls gen dua rec00 9 I D1F P 02006010120140101 N L8687002004extension L8688001003Implantable neurostimulator pulse generator, dual array, non-rechargeable, Implt nrostm pls gen dua non00 9 I D1F P 02006010120140101 N 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 L8690001003Auditory 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, excludes Aoi snd proc repl excl actua38 A C D1F P 02007010120180101 N L8691002004transducer/actuator, replacement only, each 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 L8694001003Auditory osseointegrated device, transducer/actuator, replacement only, each Aoi transducer/actuator repl38 A C D1F P 02018010120180101 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 L8696001003Antenna (external) for use with implantable diaphragmatic/phrenic nerve Ext antenna phren nerve stim38 A D 0198D1F P 02015010120150101 N L8696002004stimulation device, replacement, each L8698001003Miscellaneous component, supply or accessory for use with total artificial Misc used with tot art heart46 A D 0178D1F P 02019010120190101 A L8698002004heart system L8699001003Prosthetic implant, not otherwise specified Prosthetic implant nos 46 A C D1F P 01998010119980101 N L8701001003Powered upper extremity range of motion assist device, elbow, wrist, hand with Pow ue rom dev ewh uprt cust36 A C D1E R 02019010120190101 A L8701002004single or double upright(s), includes microprocessor, sensors, all components L8701003004and accessories, custom fabricated L8702001003Powered upper extremity range of motion assist device, elbow, wrist, hand, Pow ue rom dev ewhf uprt cus36 A C D1E R 02019010120190101 A L8702002004finger, single or double upright(s), includes microprocessor, sensors, all L8702003004components and accessories, custom fabricated 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 0199201012015010120141231N 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 M0300001003Iv 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 M1000001003Pain screened as moderate to severe Pain scr as mod to sevr 00 9 C Z2 1 02019010120190101 A M1001001003Plan of care to address moderate to severe pain documented on or before the Pln to adrs pain doc 00 9 C Z2 1 02019010120190101 A M1001002004date of the second visit with a clinician M1002001003Plan of care for moderate to severe pain not documented on or before the date Pln to adrs pain not doc 00 9 C Z2 1 02019010120190101 A M1002002004of the second visit with a clinician, reason not given M1003001003Tb screening performed and results interpreted within twelve months prior to Tb scr 12 mo pri fst bio dz 00 9 C Z2 1 02019010120190101 A M1003002004initiation of first-time biologic disease modifying anti-rheumatic drug therapy M1003003004for ra M1004001003Documentation of medical reason for not screening for tb or interpreting Doc med rsn no srn tb 00 9 C Z2 1 02019010120190101 A M1004002004results (i.e., patient positive for tb and documentation of past treatment; M1004003004patient who has recently completed a course of anti-tb therapy) M1005001003Tb screening not performed or results not interpreted, reason not given Tb scr no perf 00 9 C Z2 1 02019010120190101 A M1006001003Disease activity not assessed, reason not given Dz not ases, no rsn 00 9 C Z2 1 02019010120190101 A M1007001003>=50% of total number of a patient's outpatient ra encounters assessed >=50% total pt outpt ra enct00 9 C Z2 1 02019010120190101 A M1008001003<50% of total number of a patient's outpatient ra encounters assessed <50% total pt outpt ra encts00 9 C Z2 1 02019010120190101 A M1009001003Patient treatment and final evaluation complete Pt tx and final eval comp 00 9 C Z2 1 02019010120190101 A M1010001003Patient treatment and final evaluation complete Pt tx and final eval comp 00 9 C Z2 1 02019010120190101 A M1011001003Patient treatment and final evaluation complete Pt tx and final eval comp 00 9 C Z2 1 02019010120190101 A M1012001003Patient treatment and final evaluation complete Pt tx and final eval comp 00 9 C Z2 1 02019010120190101 A M1013001003Patient treatment and final evaluation complete Pt tx and final eval comp 00 9 C Z2 1 02019010120190101 A M1014001003Patient treatment and final evaluation complete Pt tx and final eval comp 00 9 C Z2 1 02019010120190101 A M1015001003Patient treatment and final evaluation complete Pt tx and final eval comp 00 9 C Z2 1 02019010120190101 A M1016001003Female patients unable to bear children Pt dx meop or sur steri 00 9 C Z2 1 02019010120190101 A M1017001003Patient admitted to palliative care services Pt admt to palitve serv 00 9 C Z2 1 02019010120190101 A M1018001003Patients with an active diagnosis or history of cancer (except basal cell and Pt dx hst cr pt sk lg cr scr00 9 C Z2 1 02019010120190101 A M1018002004squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung M1018003004cancer screening patients M1019001003Adolescent patients 12 to 17 years of age with major depression or dysthymia Adl pt mj dep ds rs 12 phq<500 9 C Z2 1 02019010120190101 A M1019002004who reached remission at twelve months as demonstrated by a twelve month (+/-60 M1019003004days) phq-9 or phq-9m score of less than 5 M1020001003Adolescent patients 12 to 17 years of age with major depression or dysthymia Adl pt mj dep ds no rs 12 mo00 9 C Z2 1 02019010120190101 A M1020002004who did not reach remission at twelve months as demonstrated by a twelve month M1020003004(+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score M1020004004was not assessed or is greater than or equal to 5 M1021001003Patient had only urgent care visits during the performance period Pt uc in pp 00 9 C Z2 1 02019010120190101 A M1022001003Patients who were in hospice at any time during the performance period Pt hospice during perf pd 00 9 C Z2 1 02019010120190101 A M1023001003Adolescent patients 12 to 17 years of age with major depression or dysthymia Adl pt mj dep ds rs 6 phq<5 00 9 C Z2 1 02019010120190101 A M1023002004who reached remission at six months as demonstrated by a six month (+/-60 days) M1023003004phq-9 or phq-9m score of less than five M1024001003Adolescent patients 12 to 17 years of age with major depression or dysthymia Adl pt mj dep ds no rs 6 mo 00 9 C Z2 1 02019010120190101 A M1024002004who did not reach remission at six months as demonstrated by a six month (+/-60 M1024003004days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was M1024004004not assessed or is greater than or equal to five M1025001003Patients who were in hospice at any time during the performance period Pt hospice during perf pd 00 9 C Z2 1 02019010120190101 A M1026001003Patients who were in hospice at any time during the performance period Pt hospice during perf pd 00 9 C Z2 1 02019010120190101 A M1027001003Imaging of the head (ct or mri) was obtained Img head (ct or mri) obtnd 00 9 C Z2 1 02019010120190101 A M1028001003Documentation of patients with primary headache diagnosis and imaging other Doc of pt prm hda dx and otr00 9 C Z2 1 02019010120190101 A M1028002004than ct or mri obtained M1029001003Imaging of the head (ct or mri) was not obtained, reason not given Doc sysm rsn img hd 00 9 C Z2 1 02019010120190101 A M1030001003Patients with clinical indications for imaging of the head Pt clin ind img hd 00 9 C Z2 1 02019010120190101 A M1031001003Patients with no clinical indications for imaging of the head Pt clin ind img hd 00 9 C Z2 1 02019010120190101 A M1032001003Adults currently taking pharmacotherapy for oud Adt tkng pharmthry for oud 00 9 C Z2 1 02019010120190101 A M1033001003Pharmacotherapy for oud initiated after june 30th of performance period Pharmthry for oud afr 6.30 00 9 C Z2 1 02019010120190101 A M1034001003Adults who have at least 180 days of continuous pharmacotherapy with a Adt 180 dys pharmthry oud 00 9 C Z2 1 02019010120190101 A M1034002004medication prescribed for oud without a gap of more than seven days M1035001003Adults who are deliberately phased out of medication assisted treatment (mat) Adt pd out mat pr 180 dys tx00 9 C Z2 1 02019010120190101 A M1035002004prior to 180 days of continuous treatment M1036001003Adults who have not had at least 180 days of continuous pharmacotherapy with a Adt no 180 dys pharmthry oud00 9 C Z2 1 02019010120190101 A M1036002004medication prescribed for oud without a gap of more than seven days M1037001003Patients with a diagnosis of lumbar spine region cancer at the time of the Pt dx lum sp reg cacr 00 9 C Z2 1 02019010120190101 A M1037002004procedure M1038001003Patients with a diagnosis of lumbar spine region fracture at the time of the Pt dx lum sp reg fract 00 9 C Z2 1 02019010120190101 A M1038002004procedure M1039001003Patients with a diagnosis of lumbar spine region infection at the time of the Pt dx lum sp reg inf 00 9 C Z2 1 02019010120190101 A M1039002004procedure M1040001003Patients with a diagnosis of lumbar idiopathic or congenital scoliosis Pt dx lum idi or cong scol 00 9 C Z2 1 02019010120190101 A M1041001003Patient had cancer, fracture or infection related to the lumbar spine or Pt cr ft inf lm or pt id sl 00 9 C Z2 1 02019010120190101 A M1041002004patient had idiopathic or congenital scoliosis M1042001003Functional status measurement with score was obtained utilizing the oswestry Ftl st mea sco ot odi 3 mo 00 9 C Z2 1 02019010120190101 A M1042002004disability index (odi version 2.1a) patient reported outcome tool within three M1042003004months preoperatively and at one year (9 to 15 months) postoperatively M1043001003Functional status measurement with score was not obtained utilizing the Ftl st mea sco no ot odi 00 9 C Z2 1 02019010120190101 A M1043002004oswestry disability index (odi version 2.1a) patient reported outcome tool M1043003004within three months preoperatively and at one year (9 to 15 months) M1043004004postoperatively M1044001003Functional status was measured by the oswestry disability index (odi version Ftl st mea odi 3 mo 00 9 C Z2 1 02019010120190101 A M10440020042.1a) patient reported outcome tool within three months preoperatively and at M1044003004one year (9 to 15 months) postoperatively M1045001003Functional status measurement with score was obtained utilizing the oxford knee Fsm wth scr oks pre and post00 9 C Z2 1 02019010120190101 A M1045002004score (oks) patient reported outcome tool within three months preoperatively M1045003004and at one year (9 to 15 months) postoperatively M1046001003Functional status measurement with score was not obtained utilizing the oxford Fsm wth scr no oks pre and p00 9 C Z2 1 02019010120190101 A M1046002004knee score (oks) patient reported outcome tool within three months M1046003004preoperatively and at one year (9 to 15 months) postoperatively M1047001003Functional status was measured by the oxford knee score (oks) patient reported Fs msrd oks pre and post 00 9 C Z2 1 02019010120190101 A M1047002004outcome tool within three months preoperatively and at one year (9 to 15 M1047003004months) postoperatively M1048001003Functional status measurement with score was obtained utilizing the oswestry Fsm wth scr odi pre and post00 9 C Z2 1 02019010120190101 A M1048002004disability index (odi version 2.1a) patient reported outcome tool within three M1048003004months preoperatively and at three months (6 to 20 weeks) postoperatively M1049001003Functional status measurement with score was not obtained utilizing the Fsm wth scr no odi pre and p00 9 C Z2 1 02019010120190101 A M1049002004oswestry disability index (odi version 2.1a) patient reported outcome tool M1049003004within three months preoperatively and at three months (6 to 20 weeks) M1049004004postoperatively M1050001003Functional status was measured by the oswestry disability index (odi version Fs msrd odi pre and post 00 9 C Z2 1 02019010120190101 A M10500020042.1a) patient reported outcome tool within three months preoperatively and at M1050003004three months (6 to 20 weeks) postoperatively M1051001003Patient had cancer, fracture or infection related to the lumbar spine or Pt w/cancer scoliosis 00 9 C Z2 1 02019010120190101 A M1051002004patient had idiopathic or congenital scoliosis M1052001003Leg pain was not measured by the visual analog scale (vas) within three months Lg pn nt msr vas scl pre/pst00 9 C Z2 1 02019010120190101 A M1052002004preoperatively and at one year (9 to 15 months) postoperatively M1053001003Leg pain was measured by the visual analog scale (vas) within three months Pre and post vas wthn 3 mos 00 9 C Z2 1 02019010120190101 A M1053002004preoperatively and at one year (9 to 15 months) postoperatively M1054001003Patient had only urgent care visits during the performance period Pt uc in pp 00 9 C Z2 1 02019010120190101 A M1055001003Aspirin or another antiplatelet therapy used Aspirin used 00 9 C Z2 1 02019010120190101 A M1056001003Prescribed anticoagulant medication during the performance period, history of Presc antico med in pp 00 9 C Z2 1 02019010120190101 A M1056002004gi bleeding, history of intracranial bleeding, bleeding disorder and specific M1056003004provider documented reasons: allergy to aspirin or anti-platelets, use of M1056004004non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled M1056005004hypertension > 180/110 mmhg or gastroesophageal reflux disease M1057001003Aspirin or another antiplatelet therapy not used, reason not given Aspirin not used, no rsn 00 9 C Z2 1 02019010120190101 A M1058001003Patient was a permanent nursing home resident at any time during the Pt prm nurs hm res in pp 00 9 C Z2 1 02019010120190101 A M1058002004performance period M1059001003Patient was in hospice or receiving palliative care at any time during the Pt no prm nurs hm res in pp 00 9 C Z2 1 02019010120190101 A M1059002004performance period M1060001003Patient died prior to the end of the performance period Pt died in pp 00 9 C Z2 1 02019010120190101 A M1061001003Patient pregnancy Pt preg 00 9 C Z2 1 02019010120190101 A M1062001003Patient immunocompromised Pt imcomprmd 00 9 C Z2 1 02019010120190101 A M1063001003Patients receiving high doses of immunosuppressive therapy Pt rec hg dos imsup thpy 00 9 C Z2 1 02019010120190101 A M1064001003Shingrix vaccine documented as administered or previously received Shing vac doc adm or pv rec 00 9 C Z2 1 02019010120190101 A M1065001003Shingrix vaccine was not administered for reasons documented by clinician (e.g. Shing vac no adm clinc rsn 00 9 C Z2 1 02019010120190101 A M1065002004patient administered vaccine other than shingrix, patient allergy or other M1065003004medical reasons, patient declined or other patient reasons, vaccine not M1065004004available or other system reasons) M1066001003Shingrix vaccine not documented as administered, reason not given Shing vac no doc no rsn 00 9 C Z2 1 02019010120190101 A M1067001003Hospice services for patient provided any time during the measurement period Hspc pt prv time meam per 00 9 C Z2 1 02019010120190101 A M1068001003Adults who are not ambulatory Pt not ambulatory 00 9 C Z2 1 02019010120190101 A M1069001003Patient screened for future fall risk Pt scr ft fall rsk 00 9 C Z2 1 02019010120190101 A M1070001003Patient not screened for future fall risk, reason not given Pt not scrn fut fall no rsn 00 9 C Z2 1 02019010120190101 A M1071001003Patient had any additional spine procedures performed on the same date as the Pt had add'l sp pcr perf 00 9 C Z2 1 02019010120190101 A M1071002004lumbar discectomy/laminotomy P2028001003Cephalin 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 P3000001003Screening 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 P3000002004technician 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 P7001001003Culture, 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%, 250 ml 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 P9070001003Plasma, pooled multiple donor, pathogen reduced, frozen, each unit Pathogen reduced plasma pool52 A 1833T D T1H 9 02016010120160101 N P9071001003Plasma (single donor), pathogen reduced, frozen, each unit Pathogen reduced plasma sing52 A 2455B 1833T D T1H 9 02016010120160101 N P9072001003Platelets, pheresis, pathogen reduced or rapid bacterial tested, each unit Plate path red/rapid bac tes52 A I T1H 9 0201601012018010120171231N P9073001003Platelets, pheresis, pathogen-reduced, each unit Platelets pheresis path redu52 A 2455B 1833T D T1H 9 02018010120190101 S P9100001003Pathogen(s) test for platelets Pathogen test for platelets 57 A50-34 D T1H 5 02018010120180101 N P9603001003Travel allowance one way in connection with medically necessary laboratory One-way allow prorated miles22 A 51141K D 0039Y2 5 01987010119920101 N P9603002004specimen collection drawn from home bound or nursing home bound patient; P9603003004prorated 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 5721 A 5114.1D D T1H 5 01999010120140101 N P9612002004service P9615001003Catheterization for collection of specimen(s) (multiple patients) Urine specimen collect mult 5721 A 51141D D 0040T1H 5 01985010120140101 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 (e.g., 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 technique(s) Chemo by both infusion and o00 9 C 0041O1D 1 01992010119960101 N Q0085002004(e.g., 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 CYY20170101 O1E 1P 02010010120170101 N Q0139002004on dialysis) Q0144001003Azithromycin dihydrate, oral, capsules/powder, 1 gram Azithromycin dihydrate, oral00 9 M 0054O1E 1 01996070120020701 N Q0161001003Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription Chlorpromazine hcl 5mg oral 51 A C O1D 1 02014010120140101 N Q0161002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic Q0161003004at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen 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 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 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 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 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 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 Q0477001003Power module patient cable for use with electric or electric/pneumatic Pwr module pt cable lvad rpl38 A D 0178D1F P 02018010120180101 N Q0477002004ventricular assist device, replacement only Q0478001003Power adapter for use with electric or electric/pneumatic ventricular assist Power adapter, combo vad 38 A D 0178D1F P 02011010120130101 N 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 N Q0479002004device, replacement only Q0480001003Driver for use with pneumatic ventricular assist device, replacement only Driver pneumatic vad, rep 38 A D 0178D1F P 02005100120130101 N Q0481001003Microprocessor control unit for use with electric ventricular assist device, Microprcsr cu elec vad, rep 38 A D 0178D1F P 02005100120130101 N Q0481002004replacement only Q0482001003Microprocessor control unit for use with electric/pneumatic combination Microprcsr cu combo vad, rep38 A D 0178D1F P 02005100120130101 N 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 N Q0483002004replacement only Q0484001003Monitor/display module for use with electric or electric/pneumatic ventricular Monitor elec or comb vad rep38 A D 0178D1F P 02005100120130101 N 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 N Q0485002004replacement only Q0486001003Monitor control cable for use with electric/pneumatic ventricular assist Mon cable elec/pneum vad rep38 A D 0178D1F P 02005100120130101 N Q0486002004device, replacement only Q0487001003Leads (pneumatic/electrical) for use with any type electric/pneumatic Leads any type vad, rep only38 A D 0178D1F P 02005100120130101 N 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 N Q0488002004only Q0489001003Power pack base for use with electric/pneumatic ventricular assist device, Pwr pck base combo vad, rep 38 A D 0178D1F P 02005100120130101 N Q0489002004replacement only Q0490001003Emergency power source for use with electric ventricular assist device, Emr pwr source elec vad, rep38 A D 0178D1F P 02005100120130101 N Q0490002004replacement only Q0491001003Emergency power source for use with electric/pneumatic ventricular assist Emr pwr source combo vad rep38 A D 0178D1F P 02005100120130101 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N Q0500002004replacement only Q0501001003Shower cover for use with electric or electric/pneumatic ventricular assist Shwr cov elec/combo vad, rep38 A D 0178D1F P 02005100120130101 N Q0501002004device, replacement only Q0502001003Mobility cart for pneumatic ventricular assist device, replacement only Mobility cart pneum vad, rep38 A D 0178D1F P 02005100120130101 N Q0503001003Battery for pneumatic ventricular assist device, replacement only, each Battery pneum vad replacemnt38 A D 0178D1F P 02005100120130101 N Q0504001003Power adapter for pneumatic ventricular assist device, replacement only, Pwr adpt pneum vad, rep veh 38 A D 0178D1F P 02005100120130101 N Q0504002004vehicle type Q0506001003Battery, lithium-ion, for use with electric or electric/pneumatic ventricular Lith-ion batt elec/pneum vad38 A D 0178D1F P 02010010120130101 N Q0506002004assist device, replacement only Q0507001003Miscellaneous supply or accessory for use with an external ventricular assist Misc sup/acc ext vad 46 A D 0178D1F P 02013040120130401 N Q0507002004device Q0508001003Miscellaneous supply or accessory for use with an implanted ventricular assist Mis sup/acc imp vad 46 A D 0178D1F P 02013040120130401 N Q0508002004device Q0509001003Miscellaneous supply or accessory for use with any implanted ventricular assist Mis sup/ac imp vad nopay med46 A D 0178D1F P 02013040120130401 N Q0509002004device for which payment was not made under medicare part a 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 D O1E 1P 02006010120060101 N 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 02000070120190101 P Q2017001003Injection, teniposide, 50 mg Teniposide, 50 mg 51 A 2049 1861S2B DYY20080101 O1D 1P 02000070120070101 N Q2026001003Injection, radiesse, 0.1 ml Radiesse injection 51 A DYY20190101 0166O1E 9 02010070120190101 P Q2028001003Injection, sculptra, 0.5 mg Inj, sculptra, 0.5mg 51 A DYY20190101 0166O1E 9 02014010120190101 P Q2034001003Influenza virus vaccine, split virus, for intramuscular use (agriflu) Agriflu vaccine 54 A 2049.4 D O1G V 02012070120140101 N Q2035001003Influenza virus vaccine, split virus, when administered to individuals 3 years Afluria vacc, 3 yrs & >, im 54 A 2049.4 D O1G V 02011010120140101 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 D O1G V 02011010120140101 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 D O1G V 02011010120140101 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 D O1G V 02011010120140101 N Q2038002004of age and older, for intramuscular use (fluzone) Q2039001003Influenza virus vaccine, not otherwise specified Influenza virus vaccine, nos54 A 2049.4 D O1G V 02011010120170101 N Q2040001003Tisagenlecleucel, up to 250 million car-positive viable t cells, including Tisagenlecleucel car-pos t 51 A CYY20180101 O1E 1 0201801012019010120181231D Q2040002004leukapheresis and dose preparation procedures, per infusion Q2041001003Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive Axicabtagene ciloleucel car+51 A C O1E 1 02018040120190101 C Q2041002004viable t cells, including leukapheresis and dose preparation procedures, per Q2041003004therapeutic dose Q2042001003Tisagenlecleucel, up to 600 million car-positive viable t cells, including Tisagenlecleucel car-pos t 51 A C O1E 1 02019010120190101 A Q2042002004leukapheresis and dose preparation procedures, per therapeutic dose 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 Q2049001003Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg Imported lipodox inj 51 A CYY20120701 O1D P 02012070120120701 N Q2050001003Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg Doxorubicin inj 10mg 51 A 2049.4 DYY20130701 O1D 19 02013070120130701 N Q2052001003Services, supplies and accessories used in the home under the medicare Ivig demo, services/supplies57 A D 0192O1E 9 02014040120140401 N Q2052002004intravenous immune globulin (ivig) demonstration 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 Q3027001003Injection, interferon beta-1a, 1 mcg for intramuscular use Inj beta interferon im 1 mcg51 A 2049 DYY20140101 O1E 1P 02014010120140101 N Q3028001003Injection, interferon beta-1a, 1 mcg for subcutaneous use Inj beta interferon sq 1 mcg00 9 I O1E 1P 02014010120140101 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 55 A C D1A S 02001070120141001 N Q4002001003Cast supplies, body cast adult, with or without head, fiberglass Cast sup body cast fiberglas55 A C D1A S 02001070120141001 N Q4003001003Cast supplies, shoulder cast, adult (11 years +), plaster Cast sup shoulder cast plstr55 A C D1A S 02001070120141001 N Q4004001003Cast supplies, shoulder cast, adult (11 years +), fiberglass Cast sup shoulder cast fbrgl55 A C D1A S 02001070120141001 N Q4005001003Cast supplies, long arm cast, adult (11 years +), plaster Cast sup long arm adult plst55 A C D1A S 02001070120141001 N Q4006001003Cast supplies, long arm cast, adult (11 years +), fiberglass Cast sup long arm adult fbrg55 A C D1A S 02001070120141001 N Q4007001003Cast supplies, long arm cast, pediatric (0-10 years), plaster Cast sup long arm ped plster55 A C D1A S 02001070120141001 N Q4008001003Cast supplies, long arm cast, pediatric (0-10 years), fiberglass Cast sup long arm ped fbrgls55 A C D1A S 02001070120141001 N Q4009001003Cast supplies, short arm cast, adult (11 years +), plaster Cast sup sht arm adult plstr55 A C D1A S 02001070120141001 N Q4010001003Cast supplies, short arm cast, adult (11 years +), fiberglass Cast sup sht arm adult fbrgl55 A C D1A S 02001070120141001 N Q4011001003Cast supplies, short arm cast, pediatric (0-10 years), plaster Cast sup sht arm ped plaster55 A C D1A S 02001070120141001 N Q4012001003Cast supplies, short arm cast, pediatric (0-10 years), fiberglass Cast sup sht arm ped fbrglas55 A C D1A S 02001070120141001 N Q4013001003Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years Cast sup gauntlet plaster 55 A C D1A S 02001070120141001 N Q4013002004+), plaster Q4014001003Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years Cast sup gauntlet fiberglass55 A C D1A S 02001070120141001 N Q4014002004+), fiberglass Q4015001003Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 Cast sup gauntlet ped plster55 A C D1A S 02001070120141001 N Q4015002004years), plaster Q4016001003Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 Cast sup gauntlet ped fbrgls55 A C D1A S 02001070120141001 N Q4016002004years), fiberglass Q4017001003Cast supplies, long arm splint, adult (11 years +), plaster Cast sup lng arm splint plst55 A C D1A S 02001070120141001 N Q4018001003Cast supplies, long arm splint, adult (11 years +), fiberglass Cast sup lng arm splint fbrg55 A C D1A S 02001070120141001 N Q4019001003Cast supplies, long arm splint, pediatric (0-10 years), plaster Cast sup lng arm splnt ped p55 A C D1A S 02001070120141001 N Q4020001003Cast supplies, long arm splint, pediatric (0-10 years), fiberglass Cast sup lng arm splnt ped f55 A C D1A S 02001070120141001 N Q4021001003Cast supplies, short arm splint, adult (11 years +), plaster Cast sup sht arm splint plst55 A C D1A S 02001070120141001 N Q4022001003Cast supplies, short arm splint, adult (11 years +), fiberglass Cast sup sht arm splint fbrg55 A C D1A S 02001070120141001 N Q4023001003Cast supplies, short arm splint, pediatric (0-10 years), plaster Cast sup sht arm splnt ped p55 A C D1A S 02001070120141001 N Q4024001003Cast supplies, short arm splint, pediatric (0-10 years), fiberglass Cast sup sht arm splnt ped f55 A C D1A S 02001070120141001 N Q4025001003Cast supplies, hip spica (one or both legs), adult (11 years +), plaster Cast sup hip spica plaster 55 A C D1A S 02001070120141001 N Q4026001003Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass Cast sup hip spica fiberglas55 A C D1A S 02001070120141001 N Q4027001003Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster Cast sup hip spica ped plstr55 A C D1A S 02001070120141001 N Q4028001003Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass Cast sup hip spica ped fbrgl55 A C D1A S 02001070120141001 N Q4029001003Cast supplies, long leg cast, adult (11 years +), plaster Cast sup long leg plaster 55 A C D1A S 02001070120141001 N Q4030001003Cast supplies, long leg cast, adult (11 years +), fiberglass Cast sup long leg fiberglass55 A C D1A S 02001070120141001 N Q4031001003Cast supplies, long leg cast, pediatric (0-10 years), plaster Cast sup lng leg ped plaster55 A C D1A S 02001070120141001 N Q4032001003Cast supplies, long leg cast, pediatric (0-10 years), fiberglass Cast sup lng leg ped fbrgls 55 A C D1A S 02001070120141001 N Q4033001003Cast supplies, long leg cylinder cast, adult (11 years +), plaster Cast sup lng leg cylinder pl55 A C D1A S 02001070120141001 N Q4034001003Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass Cast sup lng leg cylinder fb55 A C D1A S 02001070120141001 N Q4035001003Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster Cast sup lngleg cylndr ped p55 A C D1A S 02001070120141001 N Q4036001003Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass Cast sup lngleg cylndr ped f55 A C D1A S 02001070120141001 N Q4037001003Cast supplies, short leg cast, adult (11 years +), plaster Cast sup shrt leg plaster 55 A C D1A S 02001070120141001 N Q4038001003Cast supplies, short leg cast, adult (11 years +), fiberglass Cast sup shrt leg fiberglass55 A C D1A S 02001070120141001 N Q4039001003Cast supplies, short leg cast, pediatric (0-10 years), plaster Cast sup shrt leg ped plster55 A C D1A S 02001070120141001 N Q4040001003Cast supplies, short leg cast, pediatric (0-10 years), fiberglass Cast sup shrt leg ped fbrgls55 A C D1A S 02001070120141001 N Q4041001003Cast supplies, long leg splint, adult (11 years +), plaster Cast sup lng leg splnt plstr55 A C D1A S 02001070120141001 N Q4042001003Cast supplies, long leg splint, adult (11 years +), fiberglass Cast sup lng leg splnt fbrgl55 A C D1A S 02001070120141001 N Q4043001003Cast supplies, long leg splint, pediatric (0-10 years), plaster Cast sup lng leg splnt ped p55 A C D1A S 02001070120141001 N Q4044001003Cast supplies, long leg splint, pediatric (0-10 years), fiberglass Cast sup lng leg splnt ped f55 A C D1A S 02001070120141001 N Q4045001003Cast supplies, short leg splint, adult (11 years +), plaster Cast sup sht leg splnt plstr55 A C D1A S 02001070120141001 N Q4046001003Cast supplies, short leg splint, adult (11 years +), fiberglass Cast sup sht leg splnt fbrgl55 A C D1A S 02001070120141001 N Q4047001003Cast supplies, short leg splint, pediatric (0-10 years), plaster Cast sup sht leg splnt ped p55 A C D1A S 02001070120141001 N Q4048001003Cast supplies, short leg splint, pediatric (0-10 years), fiberglass Cast sup sht leg splnt ped f55 A C D1A S 02001070120141001 N Q4049001003Finger splint, static Finger splint, static 55 A C D1A S 02001070120141001 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 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 C O1E 1 02009010120140101 N Q4102001003Oasis wound matrix, per square centimeter Oasis wound matrix 51 A C O1E 1 02009010120140101 N Q4103001003Oasis burn matrix, per square centimeter Oasis burn matrix 51 A C O1E 1 02009010120140101 N Q4104001003Integra bilayer matrix wound dressing (bmwd), per square centimeter Integra bmwd 51 A C O1E 1 02009010120140101 N Q4105001003Integra dermal regeneration template (drt) or integra omnigraft dermal Integra drt or omnigraft 51 A C O1E 1 02009010120170101 N Q4105002004regeneration matrix, per square centimeter Q4106001003Dermagraft, per square centimeter Dermagraft 51 A C O1E 1 02009010120140101 N Q4107001003Graftjacket, per square centimeter Graftjacket 51 A C O1E 1 02009010120140101 N Q4108001003Integra matrix, per square centimeter Integra matrix 51 A C O1E 1 02009010120140101 N Q4110001003Primatrix, per square centimeter Primatrix 51 A C O1E 1 02009010120140101 N Q4111001003Gammagraft, per square centimeter Gammagraft 51 A C O1E 1 02009010120140101 N Q4112001003Cymetra, injectable, 1 cc Cymetra injectable 51 A C O1E 1 02009010120110101 N Q4113001003Graftjacket xpress, injectable, 1 cc Graftjacket xpress 51 A C O1E 1 02009010120110101 N Q4114001003Integra flowable wound matrix, injectable, 1 cc Integra flowable wound matri51 A C O1E 1 02009010120140101 N Q4115001003Alloskin, per square centimeter Alloskin 51 A C O1E 1 02009070120140101 N Q4116001003Alloderm, per square centimeter Alloderm 51 A C O1E 1 02009070120140101 N Q4117001003Hyalomatrix, per square centimeter Hyalomatrix 51 A C O1E 1 02011010120110101 N Q4118001003Matristem micromatrix, 1 mg Matristem micromatrix 51 A C O1E 1 02011010120140101 N Q4119001003Matristem wound matrix, per square centimeter Matristem wound matrix 51 A C O1E 1 0201101012017010120161231N Q4120001003Matristem burn matrix, per square centimeter Matristem burn matrix 51 A C O1E 1 0201101012017010120161231N Q4121001003Theraskin, per square centimeter Theraskin 51 A C O1E 1 02011010120180101 N Q4122001003Dermacell, per square centimeter Dermacell 51 A C O1E 1 02012010120160101 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 C O1E 1 02012010120140101 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 N Q4127001003Talymed, per square centimeter Talymed 51 A C O1E 1 02012010120160101 N Q4128001003Flex hd, allopatch hd, or matrix hd, per square centimeter Flexhd/allopatchhd/matrixhd 51 A C O1E 1 02012010120130101 N Q4129001003Unite biomatrix, per square centimeter Unite biomatrix 51 A C O1E 1 0201201012017010120161231N Q4130001003Strattice tm, per square centimeter Strattice tm 51 A C O1E 1 02012010120120101 N Q4131001003Epifix or epicord, per square centimeter Epifix or epicord 51 A C O1E 1 0201301012019010120181231D Q4132001003Grafix core and grafixpl core, per square centimeter Grafix core, grafixpl core 51 A C O1E 1 02013010120180101 N Q4133001003Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter Grafix stravix prime pl sqcm51 A C O1E 1 02013010120190101 C Q4134001003Hmatrix, per square centimeter Hmatrix 51 A C O1E 1 02013010120130101 N Q4135001003Mediskin, per square centimeter Mediskin 51 A C O1E 1 02013010120130101 N Q4136001003Ez-derm, per square centimeter Ezderm 51 A C O1E 1 02013010120130101 N Q4137001003Amnioexcel, amnioexcel plus or biodexcel, per square centimeter Amnioexcel biodexcel 1sq cm 51 A C O1E 1 02014010120190101 C Q4138001003Biodfence dryflex, per square centimeter Biodfence dryflex, 1cm 51 A C O1E 1 02014010120140101 N Q4139001003Amniomatrix or biodmatrix, injectable, 1 cc Amnio or biodmatrix, inj 1cc51 A C O1E 1 02014010120140101 N Q4140001003Biodfence, per square centimeter Biodfence 1cm 51 A C O1E 1 02014010120140101 N Q4141001003Alloskin ac, per square centimeter Alloskin ac, 1 cm 51 A C O1E 1 02014010120140101 N Q4142001003Xcm biologic tissue matrix, per square centimeter Xcm biologic tiss matrix 1cm51 A C O1E 1 02014010120140101 N Q4143001003Repriza, per square centimeter Repriza, 1cm 51 A C O1E 1 02014010120140101 N Q4145001003Epifix, injectable, 1 mg Epifix, inj, 1mg 51 A C O1E 1 02014010120140101 N Q4146001003Tensix, per square centimeter Tensix, 1cm 51 A C O1E 1 02014010120140101 N Q4147001003Architect, architect px, or architect fx, extracellular matrix, per square Architect ecm px fx 1 sq cm 51 A C O1E 1 02014010120150101 N Q4147002004centimeter Q4148001003Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter Neox neox rt or clarix cord 51 A C O1E 1 02014010120180101 N Q4149001003Excellagen, 0.1 cc Excellagen, 0.1 cc 51 A C O1E 1 02014010120140101 N Q4150001003Allowrap ds or dry, per square centimeter Allowrap ds or dry 1 sq cm 51 A C O1E 1 02015010120150101 N Q4151001003Amnioband or guardian, per square centimeter Amnioband, guardian 1 sq cm 51 A C O1E 1 02015010120150101 N Q4152001003Dermapure, per square centimeter Dermapure 1 square cm 51 A C O1E 1 02015010120150101 N Q4153001003Dermavest and plurivest, per square centimeter Dermavest, plurivest sq cm 51 A C O1E 1 02015010120160101 N Q4154001003Biovance, per square centimeter Biovance 1 square cm 51 A C O1E 1 02015010120150101 N Q4155001003Neoxflo or clarixflo, 1 mg Neoxflo or clarixflo 1 mg 51 A C O1E 1 02015010120150101 N Q4156001003Neox 100 or clarix 100, per square centimeter Neox 100 or clarix 100 51 A C O1E 1 02015010120180101 N Q4157001003Revitalon, per square centimeter Revitalon 1 square cm 51 A C O1E 1 02015010120150101 N Q4158001003Kerecis omega3, per square centimeter Kerecis omega3, per sq cm 51 A C O1E 1 02015010120180101 N Q4159001003Affinity, per square centimeter Affinity1 square cm 51 A C O1E 1 02015010120150101 N Q4160001003Nushield, per square centimeter Nushield 1 square cm 51 A C O1E 1 02015010120150101 N Q4161001003Bio-connekt wound matrix, per square centimeter Bio-connekt per square cm 51 A C O1E 1 02016010120160101 N Q4162001003Woundex flow, bioskin flow, 0.5 cc Wndex flw, bioskn flw, 0.5cc51 A C O1E 1 02016010120180101 N Q4163001003Woundex, bioskin, per square centimeter Woundex, bioskin, per sq cm 51 A C O1E 1 02016010120180101 N Q4164001003Helicoll, per square centimeter Helicoll, per square cm 51 A C O1E 1 02016010120160101 N Q4165001003Keramatrix, per square centimeter Keramatrix, per square cm 51 A C O1E 1 02016010120160101 N Q4166001003Cytal, per square centimeter Cytal, per square centimeter51 A C O1E 1 02017010120170101 N Q4167001003Truskin, per square centimeter Truskin, per sq centimeter 51 A C O1E 1 02017010120170101 N Q4168001003Amnioband, 1 mg Amnioband, 1 mg 51 A C O1E 1 02017010120170101 N Q4169001003Artacent wound, per square centimeter Artacent wound, per sq cm 51 A C O1E 1 02017010120170101 N Q4170001003Cygnus, per square centimeter Cygnus, per sq cm 51 A C O1E 1 02017010120170101 N Q4171001003Interfyl, 1 mg Interfyl, 1 mg 51 A C O1E 1 02017010120170101 N Q4172001003Puraply or puraply am, per square centimeter Puraply or puraply am 51 A C O1E 1 0201701012019010120181231D Q4173001003Palingen or palingen xplus, per square centimeter Palingen or palingen xplus 51 A C O1E 1 02017010120170101 N Q4174001003Palingen or promatrx, 0.36 mg per 0.25 cc Palingen or promatrx 51 A C O1E 1 02017010120170101 N Q4175001003Miroderm, per square centimeter Miroderm 51 A C O1E 1 02017010120170101 N Q4176001003Neopatch, per square centimeter Neopatch, per sq centimeter 51 A C O1E 1 02018010120180101 N Q4177001003Floweramnioflo, 0.1 cc Floweramnioflo, 0.1 cc 51 A C O1E 1 02018010120180101 N Q4178001003Floweramniopatch, per square centimeter Floweramniopatch, per sq cm 51 A C O1E 1 02018010120180101 N Q4179001003Flowerderm, per square centimeter Flowerderm, per sq cm 51 A C O1E 1 02018010120180101 N Q4180001003Revita, per square centimeter Revita, per sq cm 51 A C O1E 1 02018010120180101 N Q4181001003Amnio wound, per square centimeter Amnio wound, per square cm 51 A C O1E 1 02018010120180101 N Q4182001003Transcyte, per square centimeter Transcyte, per sq centimeter51 A C O1E 1 02018010120180101 N Q4183001003Surgigraft, per square centimeter Surgigraft, 1 sq cm 51 A C O1E 1 02019010120190101 A Q4184001003Cellesta, per square centimeter Cellesta, 1 sq cm 51 A C O1E 1 02019010120190101 A Q4185001003Cellesta flowable amnion (25 mg per cc); per 0.5 cc Cellesta flowab amnion 0.5cc51 A C O1E 1 02019010120190101 A Q4186001003Epifix, per square centimeter Epifix 1 sq cm 51 A C O1E 1 02019010120190101 A Q4187001003Epicord, per square centimeter Epicord 1 sq cm 51 A C O1E 1 02019010120190101 A Q4188001003Amnioarmor, per square centimeter Amnioarmor 1 sq cm 51 A C O1E 1 02019010120190101 A Q4189001003Artacent ac, 1 mg Artacent ac, 1 mg 51 A C O1E 1 02019010120190101 A Q4190001003Artacent ac, per square centimeter Artacent ac 1 sq cm 51 A C O1E 1 02019010120190101 A Q4191001003Restorigin, per square centimeter Restorigin 1 sq cm 51 A C O1E 1 02019010120190101 A Q4192001003Restorigin, 1 cc Restorigin, 1 cc 51 A C O1E 1 02019010120190101 A Q4193001003Coll-e-derm, per square centimeter Coll-e-derm 1 sq cm 51 A C O1E 1 02019010120190101 A Q4194001003Novachor, per square centimeter Novachor 1 sq cm 51 A C O1E 1 02019010120190101 A Q4195001003Puraply, per square centimeter Puraply 1 sq cm 51 A CYY20190101 O1E 1 02019010120190101 A Q4196001003Puraply am, per square centimeter Puraply am 1 sq cm 51 A CYY20190101 O1E 1 02019010120190101 A Q4197001003Puraply xt, per square centimeter Puraply xt 1 sq cm 51 A C O1E 1 02019010120190101 A Q4198001003Genesis amniotic membrane, per square centimeter Genesis amnio membrane 1sqcm51 A C O1E 1 02019010120190101 A Q4200001003Skin te, per square centimeter Skin te 1 sq cm 51 A C O1E 1 02019010120190101 A Q4201001003Matrion, per square centimeter Matrion 1 sq cm 51 A C O1E 1 02019010120190101 A Q4202001003Keroxx (2.5g/cc), 1cc Keroxx (2.5g/cc), 1cc 51 A C O1E 1 02019010120190101 A Q4203001003Derma-gide, per square centimeter Derma-gide, 1 sq cm 51 A C O1E 1 02019010120190101 A Q4204001003Xwrap, per square centimeter Xwrap 1 sq cm 51 A C O1E 1 02019010120190101 A Q5001001003Hospice or home health care provided in patient's home/residence Hospice or home hlth in home00 9 D 0133Y2 1L 02007010120130701 N Q5002001003Hospice or home health care provided in assisted living facility Hospice/home hlth in asst lv00 9 D 0133Y2 1L 02007010120130701 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 or home health care provided in place not otherwise specified (nos) Hospice/home hlth, place nos00 9 D 0133Y2 1L 02007010120130701 N Q5010001003Hospice home care provided in a hospice facility Hospice home care in hospice00 9 D 0133Y2 1L 02010100120101001 N Q5101001003Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram Injection, zarxio 51 A DYY20150701 0187O1E 1P 02015070120180401 C Q5102001003Injection, infliximab, biosimilar, 10 mg Inj., infliximab biosimilar 51 A 2049 D O1E 1P 0201607012018040120180331D Q5103001003Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg Injection, inflectra 51 A DYY20180401 0187O1E 1P 02018040120180401 A Q5104001003Injection, infliximab-abda, biosimilar, (renflexis), 10 mg Injection, renflexis 51 A DYY20180401 0187O1E 1P 02018040120180401 A Q5105001003Injection, epoetin alfa, biosimilar, (retacrit) (for esrd on dialysis), 100 Inj retacrit esrd on dialysi57 A 4273.1 DYY20180701 O1E 1L 02018070120180701 A Q5105002004units Q5106001003Injection, epoetin alfa, biosimilar, (retacrit) (for non-esrd use), 1000 units Inj retacrit non-esrd use 51 A 2049 DYY20180701 O1E 9 02018070120180701 A Q5107001003Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg Inj mvasi 10 mg 51 A D 0187O1E 1P 02019010120190101 A Q5108001003Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg Injection, fulphila 53 A CYY20181001 O1E 1P 02018100120181001 A Q5109001003Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg Injection, ixifi, 10 mg 51 A D 0187O1E 1P 02019010120190101 A Q5110001003Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram Nivestym 51 A 2049 DYY20181001 O1E 1P 02018100120181001 A Q9950001003Injection, sulfur hexafluoride lipid microspheres, per ml Inj sulf hexa lipid microsph57 A CYY20181001 I1F 4 02016010120181001 P 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 CYY20150101 I1E 4 02010010120140101 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 N Q9969002004study dose Q9970001003Injection, ferric carboxymaltose, 1mg Inj ferric carboxymaltos 1mg51 A C O1E 1P 0201407012015010120141231N Q9972001003Injection, epoetin beta, 1 microgram, (for esrd on dialysis) Epoetin beta esrd use 57 A J0887 D 0195O1E 1L 0201407012015010120141231N Q9973001003Injection, epoetin beta, 1 microgram, (non-esrd use) Epoetin beta non esrd 57 A J0888 D 0195O1E 9 0201407012015010120141231N Q9974001003Injection, morphine sulfate, preservative-free for epidural or intrathecal use, Morphine epidural/intratheca51 A60-14 2049 J2274 D O1E 1P 0201407012015010120141231N Q997400200410 mg Q9975001003Injection, factor viii fc fusion protein (recombinant), per iu Factor viii fc fusion recomb51 A J7205 D 0127O1E 1P 0201504012016010120151231N Q9976001003Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron Inj ferric pyrophosphate cit51 A J1443 C O1E 1L 0201507012016010120151231N Q9977001003Compounded drug, not otherwise classified Compounded drug noc 51 A D 0205O1E 1 0201507012016010120151231N Q9978001003Netupitant 300 mg and palonosetron 0.5 mg Netupitant palonosetron oral51 A J8655 D 0204O1E 1 0201507012016010120151231N Q9979001003Injection, alemtuzumab, 1 mg Injection, alemtuzumab 51 A J0202 D 0127O1E 1P 0201510012016010120151231N Q9980001003Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg Genvisc, inj, 1mg 51 A C O1E 1 0201601012017010120161231N Q9981001003Rolapitant, oral, 1 mg Rolapitant, oral, 1mg 51 A J8670 D 0187O1E 1 0201607012017010120161231N Q9982001003Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries Flutemetamol f18 diagnostic 00 9 D 0189I1E 4 02016070120190101 P Q9983001003Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries Florbetaben f18 diagnostic 00 9 D 0189I1E 4 02016070120190101 P Q9984001003Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg Kyleena, 19.5 mg 00 9 1862(a)(1) J7296 S P6C 9 0201707012018010120171231N Q9985001003Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg Inj hydroxyprogst capoat nos51 A J1729 C O1E 1P 0201707012018010120171231N Q9986001003Injection, hydroxyprogesterone caproate, (makena), 10 mg Makena, 10 mg 51 A J1726 C O1E 1P 0201707012018010120171231N Q9987001003Pathogen(s) test for platelets Pathogen test for platelets 57 A50-34 P9100 D T1H 5 0201707012018010120171231N Q9988001003Platelets, pheresis, pathogen-reduced, each unit Platelets, pathogen reduced 52 A 2455B 1833T P9073 D T1H 9 0201707012018010120171231N Q9989001003Ustekinumab, for intravenous injection, 1 mg Ustekinumab, iv inject,1 mg 51 A J3358 C O1E 1P 0201707012018010120171231N Q9991001003Injection, buprenorphine extended-release (sublocade), less than or equal to Buprenorph xr 100 mg or less51 A CYY20180701 O1E 1 02018070120180701 A Q9991002004100 mg Q9992001003Injection, buprenorphine extended-release (sublocade), greater than 100 mg Buprenorphine xr over 100 mg51 A CYY20180701 O1E 1 02018070120180701 A Q9993001003Injection, triamcinolone acetonide, preservative-free, extended-release, Inj., triamcinolone ext rel 51 A J3304 D 0127O1E 1P 0201807012019010120181231D Q9993002004microsphere formulation, 1 mg Q9994001003In-line cartridge containing digestive enzyme(s) for enteral feeding, each Enzyme cartridge enteral nut00 9 B4105 D 0217O1C E 0201807012019010120181231D Q9995001003Injection, emicizumab-kxwh, 0.5 mg Inj., emicizumab-kxwh 0.5 mg51 A J7170 C O1E 1 0201807012019010120181231D R0070001003Transportation 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 R0070002004home, 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, 1 mg (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 S0144001003Injection, propofol, 10 mg Inj, propofol, 10 mg 00 9 J2704 I Z2 9 0201407012015010120141231N S0145001003Injection, pegylated interferon alfa-2a, 180 mcg per ml Peg interferon alfa-2a/180 00 9 I Z2 9 02005070120050701 N S0148001003Injection, pegylated interferon alfa-2b, 10 mcg Peg interferon alfa-2b/10 00 9 I Z2 9 02010100120101001 N S0155001003Sterile dilutant for epoprostenol, 50 ml 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 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, 1 mg Anastrozole 1 mg 00 9 I 0088Z2 1P 02002010120020101 N S0171001003Injection, bumetanide, 0.5 mg Bumetanide 0.5 mg 00 9 I 0088Z2 9 02002010120020101 N S0172001003Chlorambucil, oral, 2 mg Chlorambucil 2 mg 00 9 I 0088Z2 9 02002010120020101 N S0174001003Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare Dolasetron 50 mg 00 9 I 0088Z2 9 02002010120020101 N S0174002004statute, use q0180) S0175001003Flutamide, oral, 125 mg Flutamide 125 mg 00 9 I 0088Z2 9 02002010120020101 N S0176001003Hydroxyurea, oral, 500 mg Hydroxyurea 500 mg 00 9 I 0088Z2 9 02002010120020101 N S0177001003Levamisole hydrochloride, oral, 50 mg Levamisole 50 mg 00 9 I 0088Z2 9 02002010120020101 N S0178001003Lomustine, oral, 10 mg Lomustine 10 mg 00 9 I 0088Z2 9 02002010120020101 N S0179001003Megestrol acetate, oral, 20 mg Megestrol 20 mg 00 9 I 0088Z2 1P 02002010120020101 N S0182001003Procarbazine hydrochloride, oral, 50 mg Procarbazine, oral 00 9 I 0088Z2 9 02002010120140101 N S0183001003Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the Prochlorperazine 5 mg 00 9 I 0088Z2 9 02002010120150101 N S0183002004medicare statute, use q0164) S0187001003Tamoxifen citrate, oral, 10 mg Tamoxifen 10 mg 00 9 I 0088Z2 9 02002010120020101 N S0189001003Testosterone pellet, 75 mg 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 0200301012016010120151231N S0195002004five years to nine years of age who have not previously received the vaccine 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 S0285001003Colonoscopy consultation performed prior to a screening colonoscopy procedure Cnslt before screen colonosc00 9 I 0088Z2 9 02016070120160701 N 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) S0311001003Comprehensive management and care coordination for advanced illness, per Comp mgmt care coord adv ill00 9 I Z2 9 02016070120160701 N S0311002004calendar month 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 S0353001003Treatment planning and care coordination management for cancer, initial Cancer treatmentplan initial00 9 I Z2 9 02012040120120401 N S0353002004treatment S0354001003Treatment planning and care coordination management for cancer, established Cancer treatment plan change00 9 I Z2 9 02012040120120401 N 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 N S0601001003Screening proctoscopy Screening proctoscopy 00 9 I 0088Z2 9 02000010120000101 N 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) 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) S1034001003Artificial pancreas device system (e.g., low glucose suspend (lgs) feature) Art pancreas system 00 9 I Z2 9 02014070120140701 N S1034002004including continuous glucose monitor, blood glucose device, insulin pump and S1034003004computer algorithm that communicates with all of the devices S1035001003Sensor; invasive (e.g., subcutaneous), disposable, for use with artificial Art pancreas inv disp sensor00 9 I Z2 9 02014070120140701 N S1035002004pancreas device system S1036001003Transmitter; external, for use with artificial pancreas device system Art pancreas ext transmitter00 9 I Z2 9 02014070120140701 N S1037001003Receiver (monitor); external, for use with artificial pancreas device system Art pancreas ext receiver 00 9 I Z2 9 02014070120140701 N 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 N 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 Adoptive immunotherapy 00 9 I Z2 9 02002040120020401 N S2107002004(e.g., 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 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 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 0200201012016010120151231N S2360002004injection; cervical S2361001003Each additional cervical vertebral body (list separately in addition to code Vertebroplast cerv addl 00 9 I 0088Z2 9 0200201012016010120151231N 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 D 0088Z2 9 02001010120010701 N S3620002004laboratory tests specified by the state for inclusion in this panel (e.g., S3620003004galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; S3620004004phenylalanine (pku); and thyroxine, total) 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 S3721001003Prostate cancer antigen 3 (pca3) testing Pca3 testing 00 9 I Z2 9 0201204012016010120151231N 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 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 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 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 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 02006010120160701 N S3854002004treatment S3855001003Genetic testing for detection of mutations in the presenilin - 1 gene Gene test presenilin-1 gene 00 9 I Z2 9 0200701012015010120141231N 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 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 hybridization (cgh) microarray testing for developmental Cgh test developmental delay00 9 I Z2 9 02009040120140101 N S3870002004delay, autism spectrum disorder and/or intellectual disability S3890001003Dna analysis, fecal, for colorectal cancer screening Fecal dna analysis 00 9 I Z2 9 0200404012016010120151231N 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 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 0200101012016010120151231N 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 S8032001003Low-dose computed tomography for lung cancer screening Low dose ct lung screening 00 9 G0297 I 0088Z2 9 0201410012016100120160930N 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 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 adapter Swivel adaptor 00 9 I 0088Z2 9 02002010120020101 N S8189001003Tracheostomy supply, not otherwise classified Trach supply noc 00 9 I 0088Z2 9 02002010120020101 N 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 0200204012015070120150630N 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 N 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 0200101012016010120151231N 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 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 S9110001003Telemonitoring of patient in their home, including all necessary equipment; Telemonitoring/home per mnth00 9 I Z2 9 02013010120130101 N 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 S9348002004dobutamine); 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 S9901001003Services by a journal-listed christian science nurse, per hour Christian sci nurse visit 00 9 I Z2 9 02015010120150101 N S9960001003Ambulance service, conventional air service, nonemergency transport, one way Air ambulanc nonemerg fixed 00 9 I O1A D 02014010120140101 N S9960002004(fixed wing) S9961001003Ambulance service, conventional air service, nonemergency transport, one way Air ambulan nonemerg rotary 00 9 I O1A D 02014010120140101 N S9961002004(rotary wing) 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 service(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 T1040001003Medicaid certified community behavioral health clinic services, per diem Comm bh clinic svc per diem 00 9 I Z2 9 02017010120170101 N T1041001003Medicaid certified community behavioral health clinic services, per month Comm bh clinic svc per month00 9 I Z2 9 02017010120170101 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 T4543001003Adult sized disposable incontinence product, protective brief/diaper, above Adult disp brief/diap abv xl00 960-9 M D1A 9 02007010120140101 N T4543002004extra large, each T4544001003Adult sized disposable incontinence product, protective underwear/pull-on, Adlt disp und/pull on abv xl00 960-9 M D1A 9 02014010120140101 N T4544002004above extra large, each T4545001003Incontinence product, disposable, penile wrap, each Incon disposable penile wrap00 960.9 M D1A 9 02019010120190101 A 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 V2020001003Frames, 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 V2100001003Sphere, 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 01985010119850101 N V2103001003Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to Spherocylindr 4.00d/12-2.00d38 A C D1F Q 01985010120031001 N V21030020042.00d 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 6.00d Spherocylinder 4.00d/>6.00d 38 A C D1F Q 01985010120031001 N V2106002004cylinder, per lens V2107001003Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, Spherocylinder 4.25d/12-2d 38 A C D1F Q 01985010120031001 N V2107002004.12 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 01985010119850101 N V2109002004sphere, 4.25 to 6.00d cylinder, per lens V2110001003Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d Spherocylinder 4.25d/over 6d38 A C D1F Q 01985010120031001 N V2110002004cylinder, 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 V2200001003Sphere, 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,.12 Lens sphcy bifocal 4.25-7d/.38 A C D1F Q 01985010120031001 N V2207002004to 2.00d cylinder, per lens V2208001003Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 Lens sphcy bifocal 4.25-7/2.38 A C D1F Q 01985010120031001 N V2208002004to 4.00d cylinder, per lens V2209001003Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 Lens sphcy bifocal 4.25-7/4.38 A C D1F Q 01985010119850101 N V2209002004to 6.00d cylinder, per lens V2210001003Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over Lens sphcy bifocal 4.25-7/ov38 A C D1F Q 01985010119850101 N V22100020046.00d cylinder, per lens V2211001003Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 Lens sphcy bifo 7.25-12/.25-38 A C D1F Q 01985010120031001 N V2211002004to 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 28 mm Lens bifocal seg width over 38 A C D1F Q 01985010119850101 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 V2300001003Sphere, 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 01985010119850101 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, .12 Lens sphcy trifocal 4.25-7/.38 A C D1F Q 01985010120031001 N V2307002004to 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 V2311002004.25 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 01985010119850101 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 V2410001003Variable 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 V2500001003Contact 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 01985010119850101 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, hydrophilic, bifocal, per lens Cntct lens hydrophil bifocl 38 A45-7 65-1 D D1F Q 01985010119850101 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 V2600001003Hand 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 V2630001003Anterior chamber intraocular lens Anter chamber intraocul lens56 A 2130 D D1F Q 01985010120141001 N V2631001003Iris supported intraocular lens Iris support intraoclr lens 56 A 2130 D D1F Q 01985010120141001 N V2632001003Posterior chamber intraocular lens Post chmbr intraocular lens 56 A 2130 D D1F Q 01985010120141001 N V2700001003Balance 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 polycarbonate, Lens, 1.54-1.65 p/1.60-1.79g38 A 2130.B D D1F Q 02004010120040101 N V2782002004per 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 item or service, miscellaneous Misc vision item or service 46 A C D1F Q 01985010120150101 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 0198201012019010120181231D V5171001003Hearing aid, contralateral routing device, monaural, in the ear (ite) Hearing aid monaural ite 00 9 1862A7 S O1F K 02019010120190101 A V5172001003Hearing aid, contralateral routing device, monaural, in the canal (itc) Hearing aid monaural itc 00 9 1862A7 S O1F K 02019010120190101 A V5180001003Hearing aid, cros, behind the ear Behind ear cros hearing aid 00 9 1862A7 S O1F K 0198201012019010120181231D V5181001003Hearing aid, contralateral routing device, monaural, behind the ear (bte) Hearing aid monaural bte 00 9 1862A7 S O1F K 02019010120190101 A V5190001003Hearing aid, contralateral routing, monaural, glasses Hearing aid monaural glasses00 9 1862A7 S O1F K 01982010120190101 C V5200001003Dispensing fee, contralateral, monaural Disp fee contralateral monau00 9 1862A7 S O1F K 01982010120190101 C V5210001003Hearing aid, bicros, in the ear In ear bicros hearing aid 00 9 1862A7 S O1F K 0198201012019010120181231D V5211001003Hearing aid, contralateral routing system, binaural, ite/ite Hearing aid binaural ite/ite00 9 1862A7 S O1F K 02019010120190101 A V5212001003Hearing aid, contralateral routing system, binaural, ite/itc Hearing aid binaural ite/itc00 9 1862A7 S O1F K 02019010120190101 A V5213001003Hearing aid, contralateral routing system, binaural, ite/bte Hearing aid binaural ite/bte00 9 1862A7 S O1F K 02019010120190101 A V5214001003Hearing aid, contralateral routing system, binaural, itc/itc Hearing aid binaural itc/itc00 9 1862A7 S O1F K 02019010120190101 A V5215001003Hearing aid, contralateral routing system, binaural, itc/bte Hearing aid binaural itc/bte00 9 1862A7 S O1F K 02019010120190101 A V5220001003Hearing aid, bicros, behind the ear Behind ear bicros hearing ai00 9 1862A7 S O1F K 0198201012019010120181231D V5221001003Hearing aid, contralateral routing system, binaural, bte/bte Hearing aid binaural bte/bte00 9 1862A7 S O1F K 02019010120190101 A V5230001003Hearing aid, contralateral routing system, binaural, glasses Hearing aid binaural glasses00 9 1862A7 S O1F K 01982010120190101 C V5240001003Dispensing fee, contralateral routing system, binaural Disp fee contralateral binau00 9 1862A7 S O1F K 01982010120190101 C 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 N 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 N 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 N 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 N V5284001003Assistive listening device, personal fm/dm, ear level receiver Ald fm/dm ear level receiver00 9 1862a7 S O1F K 02013010120130101 N V5285001003Assistive listening device, personal fm/dm, direct audio input receiver Ald fm/dm aud input receiver00 9 1862a7 S O1F K 02013010120130101 N V5286001003Assistive listening device, personal blue tooth fm/dm receiver Ald blu tooth fm/dm receiver00 9 1862a7 S O1F K 02013010120130101 N V5287001003Assistive listening device, personal fm/dm receiver, not otherwise specified Ald fm/dm receiver, nos 00 9 1862a7 S O1F K 02013010120130101 N V5288001003Assistive listening device, personal fm/dm transmitter assistive listening Ald fm/dm transmitter ald 00 9 1862a7 S O1F K 02013010120130101 N V5288002004device V5289001003Assistive listening device, personal fm/dm adapter/boot coupling device for Ald fm/dm adapt/boot couplin00 9 1862a7 S 0000O1F K 02013010120130101 N V5289002004receiver, any type V5290001003Assistive listening device, transmitter microphone, any type Ald transmitter microphone 00 9 1862a7 S O1F K 02013010120130101 N 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