Note regarding coverage and payment indicators for codes in CMS’ 2020 HCPCS Update and DMEPOS Fee Schedule Files If specific Medicare coverage or payment indicators or values have not been established for any new HCPCS codes, this may be because a national Medicare coverage determination and/or fee schedule amounts have not yet been established for these items. This is neither an indicator of Medicare coverage or non-coverage. In these cases, until national Medicare coverage and payment guidelines have been established for these codes, the Medicare coverage and payment determinations for these items may be made based on the discretion of the Medicare contractors processing claims for these items. 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 N 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 N 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 DA001007Oral health assessment by a licensed health professional other than a dentist Oral health assess, not dent C 2011010120110101 N 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 N 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 N 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 200801012020010120191231D 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 MA001007Ordering professional is not required to consult a clinical decision support Emer med cond susp/confirm C 2020010120200101 A MA002008mechanism due to service being rendered to a patient with a suspected or MA003008confirmed emergency medical condition MB001007Ordering professional is not required to consult a clinical decision support Auc hardship, insuf internet C 2020010120200101 A MB002008mechanism due to the significant hardship exception of insufficient internet MB003008access MC001007Ordering professional is not required to consult a clinical decision support Auc hardship, vendor issues C 2020010120200101 A MC002008mechanism due to the significant hardship exception of electronic health record MC003008or clinical decision support mechanism vendor issues MD001007Ordering professional is not required to consult a clinical decision support Auc hardship, extreme circ C 2020010120200101 A MD002008mechanism due to the significant hardship exception of extreme and MD003008uncontrollable circumstances ME001007The order for this service adheres to appropriate use criteria in the clinical Order adheres to auc C 2020010120200101 A ME002008decision support mechanism consulted by the ordering professional MF001007The order for this service does not adhere to the appropriate use criteria in Order does not adhere to auc C 2020010120200101 A MF002008the clinical decision support mechanism consulted by the ordering professional MG001007The order for this service does not have applicable appropriate use criteria in Auc not applicable to order C 2020010120200101 A MG002008the qualified clinical decision support mechanism consulted by the ordering MG003008professional MH001007Unknown if ordering professional consulted a clinical decision support Auc consult not provided C 2020010120200101 A MH002008mechanism for this service, related information was not provided to the MH003008furnishing professional or provider 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 N 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 N 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 N QE002008minute (lpm) QF001007Prescribed amount of stationary oxygen while at rest exceeds 4 liters per Station o2 @ rest >4lpm/port C 1989010120180401 N 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 N 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 N 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 N 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 N 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 201601012018040120180331N ZB001007Pfizer/hospira Pfizer/hospira C 201607012018040120180331N ZC001007Merck/samsung bioepis Merck/samsung bioepis C 201710012018040120180331N 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 019820101 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 019820101 N A0190001003Non-emergency transportation: ancillary: meals-recipient Noner transport meals recip 00 9 I O1A D 019840101 N A0200001003Non-emergency transportation: ancillary: lodging escort Noner transport lodgng escrt00 9 I O1A D 019820101 N A0210001003Non-emergency transportation: ancillary: meals-escort Noner transport meals escort00 9 I O1A D 019840101 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 A4226001003Supplies for maintenance of insulin infusion pump with dosage rate adjustment Weekly supply maint cgs pump99 9 C Z2 9 02020010120200101 A A4226002004using therapeutic continuous glucose sensing, per week 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 N 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 019820101 N A4590001003Special casting material (e.g., fiberglass) Special casting material 00 9 2079 I D1A 9 019840101 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 019910101 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 019910101 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 N A5512002004after external heat source of 230 degrees fahrenheit or higher, total contact A5512003004with patient's foot, including arch, base layer minimum of 1/4 inch material of A5512004004shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), A5512005004prefabricated, each A5513001003For diabetics only, multiple density insert, custom molded from model of Multi den insert custom mold38 A 2134 D D1F J 02006010120190101 N A5513002004patient's foot, total contact with patient's foot, including arch, base layer A5513003004minimum of 3/16 inch material of shore a 35 durometer (or higher), includes 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 N 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 N 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 N 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 N 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 N A9515001003Choline c-11, diagnostic, per study dose up to 20 millicuries Choline c-11 57 A C I1E 4 02017010120190101 N A9516001003Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 Iodine i-123 sod iodide mic 57 A C I1E 4 02003010120080101 N A9516002004microcuries A9517001003Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie I131 iodide cap, rx 57 A C I1E 6 02003010120060101 N 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 N 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 N A9590001003Iodine i-131, iobenguane, 1 millicurie Iodine i-131 iobenguane 1mci51 A CYY20200101 I1E 4 02020010120200101 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 nut39 A Q9994 C O1C E 02019010120190101 N B4149001003Enteral formula, manufactured blenderized natural foods with intact nutrients, Ef blenderized foods 39 A65-10 2130 4450 D O1C E 02005010120060101 N B4149002004includes proteins, fats, carbohydrates, vitamins and minerals, may include B4149003004fiber, administered through an enteral feeding tube, 100 calories = 1 unit B4150001003Enteral formula, nutritionally complete with intact nutrients, includes Ef complet w/intact nutrient39 A65-10 2130 4450 D O1C E 01986010120050101 N B4150002004proteins, fats, carbohydrates, vitamins and minerals, may include fiber, B4150003004administered through an enteral feeding tube, 100 calories = 1 unit B4152001003Enteral formula, nutritionally complete, calorically dense (equal to or greater Ef calorie dense>/=1.5kcal 39 A65-10 2130 4450 D O1C E 01984010120050101 N B4152002004than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, B4152003004carbohydrates, vitamins and minerals, may include fiber, administered through B4152004004an enteral feeding tube, 100 calories = 1 unit B4153001003Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and Ef hydrolyzed/amino acids 39 A65-10 2130 4450 D O1C E 01986010120050101 N B4153002004peptide chain), includes fats, carbohydrates, vitamins and minerals, may B4153003004include fiber, administered through an enteral feeding tube, 100 calories = 1 B4153004004unit B4154001003Enteral formula, nutritionally complete, for special metabolic needs, excludes Ef spec metabolic noninherit39 A65-10 2130 4450 D O1C E 01984010120050101 N B4154002004inherited disease of metabolism, includes altered composition of proteins, B4154003004fats, carbohydrates, vitamins and/or minerals, may include fiber, administered B4154004004through an enteral feeding tube, 100 calories = 1 unit B4155001003Enteral formula, nutritionally incomplete/modular nutrients, includes specific Ef incomplete/modular 39 A65-10 2130 4450 D O1C E 01986010120050101 N B4155002004nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., B4155003004glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, B4155004004administered through an enteral feeding tube, 100 calories = 1 unit B4157001003Enteral formula, nutritionally complete, for special metabolic needs for Ef special metabolic inherit39 A65-10 D O1C E 02005010120050101 N B4157002004inherited disease of metabolism, includes proteins, fats, carbohydrates, B4157003004vitamins and minerals, may include fiber, administered through an enteral B4157004004feeding tube, 100 calories = 1 unit B4158001003Enteral formula, for pediatrics, nutritionally complete with intact nutrients, Ef ped complete intact nut 46 A65-10 D O1C E 02005010120050101 N B4158002004includes proteins, fats, carbohydrates, vitamins and minerals, may include B4158003004fiber and/or iron, administered through an enteral feeding tube, 100 calories = B41580040041 unit B4159001003Enteral formula, for pediatrics, nutritionally complete soy based with intact Ef ped complete soy based 46 A65-10 D O1C E 02005010120050101 N B4159002004nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may B4159003004include fiber and/or iron, administered through an enteral feeding tube, 100 B4159004004calories = 1 unit B4160001003Enteral formula, for pediatrics, nutritionally complete calorically dense Ef ped caloric dense>/=0.7kc46 A65-10 D O1C E 02005010120050101 N B4160002004(equal to or greater than 0.7 kcal/ml) with intact nutrients, includes B4160003004proteins, fats, carbohydrates, vitamins and minerals, may include fiber, B4160004004administered through an enteral feeding tube, 100 calories = 1 unit B4161001003Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain Ef ped hydrolyzed/amino acid46 A65-10 D O1C E 02005010120050101 N B4161002004proteins, includes fats, carbohydrates, vitamins and minerals, may include B4161003004fiber, administered through an enteral feeding tube, 100 calories = 1 unit B4162001003Enteral formula, for pediatrics, special metabolic needs for inherited disease Ef ped specmetabolic inherit46 A65-10 D O1C E 02005010120050101 N B4162002004of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, B4162003004may include fiber, administered through an enteral feeding tube, 100 calories = B41620040041 unit B4164001003Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = Parenteral 50% dextrose solu39 A65-10 2130 4450 D O1C E 01986010120020101 N B41640020041 unit) - 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, not otherwise specified, 10 grams lipids Pn soln nos 10 grams lipids 39 A D 0126O1C E 02006010120200101 C B4187001003Omegaven, 10 grams lipids Omegaven, 10 grams lipids 39 A D 0126O1C E 02020010120200101 A 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 C1734001003Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone Orth/devic/drug bn/bn,tis/bn53 A 1833(T) DYY20200101 D1A 9F 02020010120200101 A C1734002004(implantable) 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 N C1823002004sensing and stimulation leads C1824001003Generator, cardiac contractility modulation (implantable) Generator, ccm, implant 53 A 1833(T) DYY20200101 D1A 9F 02020010120200101 A C1830001003Powered bone marrow biopsy needle Power bone marrow bx needle 53 A 1833(t) D D1A 9S 02011100120140101 N C1839001003Iris prosthesis Iris prosthesis 53 A 1833(T) DYY20200101 D1A 9FS 02020010120200101 A 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 020010401 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 N C1890001003No implantable/insertable device used with device-intensive procedures No device w/dev-intensive px53 A 1833(t) DYY20190101 D1E 9F 02019010120190101 N C1891001003Infusion pump, non-programmable, permanent (implantable) Infusion pump,non-prog, perm53 A 1833(T) D D1A 9S 02001040120040101 N C1892001003Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, Intro/sheath,fixed,peel-away53 A 1833(T) D D1A 9S 02001040120040101 N C1892002004peel-away C1893001003Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, Intro/sheath, fixed,non-peel53 A 1833(T) D D1A 9S 02001040120040101 N C1893002004other than peel-away C1894001003Introducer/sheath, other than guiding, other than intracardiac Intro/sheath, non-laser 53 A 1833(T) D D1A 9S 02001040120020701 N C1894002004electrophysiological, non-laser C1895001003Lead, cardioverter-defibrillator, endocardial dual coil (implantable) Lead, aicd, endo dual coil 53 A 1833(T) D D1A 9S 02001040120040101 N C1896001003Lead, cardioverter-defibrillator, other than endocardial single or dual coil Lead, aicd, non sing/dual 53 A 1833(T) D D1A 9S 02001040120040101 N C1896002004(implantable) C1897001003Lead, neurostimulator test kit (implantable) Lead, neurostim test kit 53 A 1833(T) D D1A 9S 02001040120040101 N C1898001003Lead, pacemaker, other than transvenous vdd single pass Lead, pmkr, other than trans53 A 1833(T) D D1A 9S 02001040120040101 N C1899001003Lead, pacemaker/cardioverter-defibrillator combination (implantable) Lead, pmkr/aicd combination 53 A 1833(T) D D1A 9S 02001040120040101 N C1900001003Lead, left ventricular coronary venous system Lead, coronary venous 53 A 1833(T) D D1A 9S 02002070120020701 N C1982001003Catheter, pressure-generating, one-way valve, intermittently occlusive Cath, pressure,valve-occlu 53 A 1833(T) DYY20200101 D1A 9F 02020010120200101 A C2596001003Probe, image-guided, robotic, waterjet ablation Probe, robotic, water-jet 53 A 1833(T) DYY20200101 D1A 9F 02020010120200101 A 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 N 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 0200110012019010120181231N 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 0200110012019010120181231N 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 N 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 0201801012019010120181231N C9015001003Injection, c-1 esterase inhibitor (human), haegarda, 10 units C-1 esterase, haegarda 53 A 1833(t) J0599 DYY20180101 O1E 9F 0201801012019010120181231N C9016001003Injection, triptorelin extended release, 3.75 mg Inj, triptorelin ext rel 53 A 1833(t) J3316 DYY20180101 O1E 9F 0201801012019010120181231N 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 0201801012019010120181231N 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 0201801012019010120181231N C9029001003Injection, guselkumab, 1 mg Injection, guselkumab 53 A 1833(t) J1628 DYY20180101 O1E 9F 0201801012019010120181231N C9030001003Injection, copanlisib, 1 mg Inj copanlisib 53 A 1833(t) J9057 D O1D 9F 0201807012019010120181231N C9031001003Lutetium lu 177, dotatate, therapeutic, 1 mci Lutetium lu 177 dotatate, tx53 A 1833(t) A9513 D O1D 9F 0201807012019010120181231N C9032001003Injection, voretigene neparvovec-rzyl, 1 billion vector genome Voretigene neparvovec-rzyl 53 A 1833(t) J3398 D O1E 9F 0201807012019010120181231N C9033001003Injection, fosnetupitant 235 mg and palonosetron 0.25 mg Inj, akynzeo 53 A 1833(t) J1454 D O1E 9F 0201810012019010120181231N C9034001003Injection, dexamethasone 9%, intraocular, 1 mcg Injection, dexamethasone 9% 53 A 1833(t) J1095 D O1E 9F 0201810012019010120181231N C9035001003Injection, aripiprazole lauroxil (aristada initio), 1 mg Injection, aristada initio 53 A 1833(t) D O1E 9F 0201901012019100120190930D C9036001003Injection, patisiran, 0.1 mg Injection, patisiran 53 A 1833(t) D O1E 9F 0201901012019100120190930D C9037001003Injection, risperidone (perseris), 0.5 mg Injection, risperidone 53 A 1833(t) D O1E 9F 0201901012019100120190930D C9038001003Injection, mogamulizumab-kpkc, 1 mg Inj mogamulizumab-kpkc 53 A 1833(t) D O1E 9F 0201901012019100120190930D C9039001003Injection, plazomicin, 5 mg Injection, plazomicin 53 A 1833(t) D O1E 9F 0201901012019100120190930D C9040001003Injection, fremanezumab-vfrm, 1mg Injection, fremanezumab-vfrm53 A 1833(t) J3031 D O1E 9F 0201904012019100120190930D C9041001003Injection, coagulation factor xa (recombinant), inactivated (andexxa), 10 mg Inj, coagulation factor xa 53 A 1833(t) DYY20190401 O1E 9F 02019040120190401 A C9042001003Injection, bendamustine hcl (belrapzo), 1 mg Inj., belrapzo 1 mg 53 A 1833(t) D O1D 9F 0201904012019070120190630D C9043001003Injection, levoleucovorin, 1 mg Injection, levoleucovorin 53 A 1833(t) J0642 D O1E 9F 0201904012020010120191231D C9044001003Injection, cemiplimab-rwlc, 1 mg Injection, cemiplimab-rwlc 53 A 1833(t) J9119 D O1D 9F 0201904012019100120190930D C9045001003Injection, moxetumomab pasudotox-tdfk, 0.01 mg Moxetumomab pasudotox-tdfk 53 A 1833(t) J9313 D O1D 9F 0201904012019100120190930D C9046001003Cocaine hydrochloride nasal solution for topical administration, 1 mg Cocaine hcl nasal solution 53 A 1833(t) DYY20190401 O1E 9F 02019040120190401 A C9047001003Injection, caplacizumab-yhdp, 1 mg Injection, caplacizumab-yhdp53 A 1833(t) DYY20190701 O1E 9F 02019070120190701 A C9048001003Dexamethasone, lacrimal ophthalmic insert, 0.1 mg Dexamethasone ophth insert 53 A 1833(t) J1096 D O1E 9F 0201907012019100120190930D C9049001003Injection, tagraxofusp-erzs, 10 mcg Injection, tagraxofusp-erzs 53 A 1833(t) J9269 D O1D 9F 0201907012019100120190930D C9050001003Injection, emapalumab-lzsg, 1 mg Injection, emapalumab-lzsg 53 A 1833(t) J9210 D O1E 9F 0201907012019100120190930D C9051001003Injection, omadacycline, 1 mg Injection, omadacycline 53 A 1833(t) J0121 D O1E 9F 0201907012019100120190930D C9052001003Injection, ravulizumab-cwvz, 10 mg Injection, ravulizumab-cwv 53 A 1833(t) J1303 D O1E 9F 0201907012019100120190930D C9054001003Injection, lefamulin (xenleta), 1 mg Injection, lefamulin 53 A 1833(T) DYY20200101 O1E 9F 02020010120200101 A C9055001003Injection, brexanolone, 1mg Inj, brexanolone 53 A 1833(T) DYY20200101 O1E 9F 02020010120200101 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 C9141001003Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl Factor viii pegylated-aucl 53 A 1833(t) D O1E 9F 0201904012019070120190630D C9141002004(jivi), 1 i.u. C9248001003Injection, clevidipine butyrate, 1 mg Inj, clevidipine butyrate 53 A 1833(t) DYY20190101 O1E 1 02009010120190101 N 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 0201101012019010120181231N 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 N 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) D I1E 4 0201901012020010120191231D C9408001003Iodine i-131 iobenguane, therapeutic, 1 millicurie Iodine i-131 iobenguane, tx 53 A 1833(t) A9590 DYY20190101 I1E 4 0201901012020010120191231D 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) D O1E 9F 0201501012019100120190930D 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 N C9463001003Injection, aprepitant, 1 mg Injection, aprepitant 53 A 1833(t) J0185 D O1E 9F 0201804012019010120181231N C9464001003Injection, rolapitant, 0.5 mg Injection, rolapitant 53 A 1833(t) J2797 D O1E 9F 0201804012019010120181231N C9465001003Hyaluronan or derivative, durolane, for intra-articular injection, per dose Injection, durolane 53 A 1833(t) J7318 D O1E 9F 0201804012019010120181231N C9466001003Injection, benralizumab, 1 mg Injection, benralizumab 53 A 1833(t) J0517 D O1E 9F 0201804012019010120181231N C9467001003Injection, rituximab and hyaluronidase, 10 mg Inj rituximab hyaluronidase 53 A 1833(t) J9311 D O1E 9F 0201804012019010120181231N C9468001003Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, Inj, factor ix, rebinyn 53 A 1833(t) J7203 D O1E 9F 0201804012019010120181231N C9468002004rebinyn, 1 i.u. C9469001003Injection, triamcinolone acetonide, preservative-free, extended-release, Inj triamcinolone acetonide 53 A 1833(t) Q9993 D O1E 9F 0201804012018070120180630N 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 0201710012019010120181231N C9493001003Injection, edaravone, 1 mg Injection, edaravone 53 A 1833(t) J1301 DYY20171001 O1E 9F 0201710012019010120181231N 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 0201401012019010120181231N C9600001003Percutaneous transcatheter placement of drug eluting intracoronary stent(s), Perc drug-el cor stent sing 53 A 1833(t) DYY20200101 0107P2F 2 02013010120200101 P 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 0201410012019010120181231N 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 0201610012019010120181231N 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) D P6C 2F 0201707012019070120190630D 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 0201801012019010120181231N 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 N C9750001003Insertion or removal and replacement of intracardiac ischemia monitoring system Ins/rem-replace compl iims 53 A 1833(t) 0525T D P6C 2F 0201810012019010120181231N 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 N 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 N 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 N 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 N 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 N 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 C9756001003Intraoperative near-infrared fluorescence lymphatic mapping of lymph node(s) Fluorescence lymph map w/icg53 A 1833(t) D I4B 4 02019070120190701 A C9756002004(sentinel or tumor draining) with administration of indocyanine green (icg) C9756003004(list separately in addition to code for primary procedure) C9757001003Laminotomy (hemilaminectomy), with decompression of nerve root(s), including Spine/lumbar disk surgery 53 A 1833(T) DYY20200101 P6B 1 02020010120200101 A C9757002004partial facetectomy, foraminotomy and excision of herniated intervertebral C9757003004disc, and repair of annular defect with implantation of bone anchored annular C9757004004closure device, including annular defect measurement, alignment and sizing C9757005004assessment, and image guidance; 1 interspace, lumbar C9758001003Blinded procedure for nyha class iii/iv heart failure; transcatheter Interatrial shunt ide 53 A 1833(T) D P2F 2 02020010120200101 A C9758002004implantation of interatrial shunt or placebo control, including right heart C9758003004catheterization, trans-esophageal echocardiography (tee)/intracardiac C9758004004echocardiography (ice), and all imaging with or without guidance (e.g., C9758005004ultrasound, fluoroscopy), performed in an approved investigational device C9758006004exemption (ide) study 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 ALPR 01986010120030101 N E0215001003Electric heat pad, moist Electric heat pad moist 32 A60-9 D D1E APR 01986010119960101 N E0217001003Water circulating heat pad with pump Water circ heat pad w pump 32 A60-9 D D1E APR 01997010119970101 N E0218001003Fluid circulating cold pad with pump, any type Fluid circ cold pad w pump 36 A60-9 D D1E APR 01997010120190101 N 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 N 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 N 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 N 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 019860101 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 019820101 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 AEPR 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) E0787001003External ambulatory infusion pump, insulin, dosage rate adjustment using Cgs dose adj insulin inf pmp99 9 C Z2 9 02020010120200101 A E0787002004therapeutic continuous glucose sensing 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 N E2351002004device using power wheelchair control interface E2358001003Power wheelchair accessory, group 34 non-sealed lead acid battery, each Gr 34 nonsealed leadacid 32 A C D1D APR 02012010120120101 N E2359001003Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel Gr34 sealed leadacid battery32 A C D1D APR 02012010120120101 N E2359002004cell, absorbed glassmat) E2360001003Power wheelchair accessory, 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 E2398001003Wheelchair accessory, dynamic positioning hardware for back Wc dynamic pos back hardware46 A C D1D 9 02020010120200101 A 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 N 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 N E2502002004greater than 8 minutes but less than or equal to 20 minutes recording time E2504001003Speech generating device, digitized speech, using pre-recorded messages, Sgd prerec msg>20min <=40min32 A60-23 D D1E APR 02004010120190101 N E2504002004greater than 20 minutes but less than or equal to 40 minutes recording time E2506001003Speech generating device, digitized speech, using pre-recorded messages, Sgd prerec msg > 40 min 32 A60-23 D D1E APR 02004010120190101 N E2506002004greater than 40 minutes recording time E2508001003Speech generating device, synthesized speech, requiring message formulation by Sgd spelling phys contact 32 A60-23 D D1E APR 02004010120190101 N E2508002004spelling and access by physical contact with the device E2510001003Speech generating device, synthesized speech, permitting multiple methods of Sgd w multi methods msg/accs32 A60-23 D D1E APR 02004010120190101 N E2510002004message formulation and multiple methods of device access E2511001003Speech generating software program, for personal computer or personal digital Sgd sftwre prgrm for pc/pda 32 A60-23 D D1E APR 02004010120040101 N E2511002004assistant E2512001003Accessory for speech generating device, mounting system Sgd accessory, mounting sys 32 A60-23 D D1E APR 02004010120040101 N E2599001003Accessory for speech generating device, not otherwise classified Sgd accessory noc 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 N 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 020020101 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 C P9A 5 0200501012020010120191231D 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 N 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 0201801012020010120191231D 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 N 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 G1000001003Clinical decision support mechanism applied pathways, as defined by the Cdsm applied pathways 00 9 C Z2 1 02020010120200101 A G1000002004medicare appropriate use criteria program G1001001003Clinical decision support mechanism evicore, as defined by the medicare Cdsm evicore 00 9 C Z2 1 02020010120200101 A G1001002004appropriate use criteria program G1002001003Clinical decision support mechanism medcurrent, as defined by the medicare Cdsm medcurrent 00 9 C Z2 1 02020010120200101 A G1002002004appropriate use criteria program G1003001003Clinical decision support mechanism medicalis, as defined by the medicare Cdsm medicalis 00 9 C Z2 1 02020010120200101 A G1003002004appropriate use criteria program G1004001003Clinical decision support mechanism national decision support company, as Cdsm ndsc 00 9 C Z2 1 02020010120200101 A G1004002004defined by the medicare appropriate use criteria program G1005001003Clinical decision support mechanism national imaging associates, as defined by Cdsm nia 00 9 C Z2 1 02020010120200101 A G1005002004the medicare appropriate use criteria program G1006001003Clinical decision support mechanism test appropriate, as defined by the Cdsm test approp 00 9 C Z2 1 02020010120200101 A G1006002004medicare appropriate use criteria program G1007001003Clinical decision support mechanism aim specialty health, as defined by the Cdsm aim 00 9 C Z2 1 02020010120200101 A G1007002004medicare appropriate use criteria program G1008001003Clinical decision support mechanism cranberry peak, as defined by the medicare Cdsm cranberry pk 00 9 C Z2 1 02020010120200101 A G1008002004appropriate use criteria program G1009001003Clinical decision support mechanism sage health management solutions, as Cdsm sage health 00 9 C Z2 1 02020010120200101 A G1009002004defined by the medicare appropriate use criteria program G1010001003Clinical decision support mechanism stanson, as defined by the medicare Cdsm stanson 00 9 C Z2 1 02020010120200101 A G1010002004appropriate use criteria program G1011001003Clinical decision support mechanism, qualified tool not otherwise specified, as Cdsm qualified nos 00 9 C Z2 1 02020010120200101 A G1011002004defined by the medicare appropriate use criteria program G2000001003Blinded administration of convulsive therapy procedure, either Blinded conv. tx mdd clin tr00 9 C P6D 1 02018080120180801 N 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 G2001001003Brief (20 minutes) in-home visit for a new patient post-discharge. for use only Post d/c h vst new pt 20 m 13 A C M4A 1 02019010120190101 N G2001002004in a medicare-approved cmmi model. (services must be furnished within a G2001003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2001004004facility within 90 days following discharge from an inpatient facility and no G2001005004more than 9 times.) G2002001003Limited (30 minutes) in-home visit for a new patient post-discharge. for use Post-d/c h vst new pt 30 m 13 A C M4A 1 02019010120190101 N G2002002004only in a medicare-approved cmmi model. (services must be furnished within a G2002003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2002004004facility within 90 days following discharge from an inpatient facility and no G2002005004more than 9 times.) G2003001003Moderate (45 minutes) in-home visit for a new patient post-discharge. for use Post-d/c h vst new pt 45 m 13 A C M4A 1 02019010120190101 N G2003002004only in a medicare-approved cmmi model. (services must be furnished within a G2003003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2003004004facility within 90 days following discharge from an inpatient facility and no G2003005004more than 9 times.) G2004001003Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for Post-d/c h vst new pt 60 m 13 A C M4A 1 02019010120190101 N G2004002004use only in a medicare-approved cmmi model. (services must be furnished within G2004003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2004004004facility within 90 days following discharge from an inpatient facility and no G2004005004more than 9 times.) G2005001003Extensive (75 minutes) in-home visit for a new patient post-discharge. for use Post-d/c h vst new pt 75 m 13 A C M4A 1 02019010120190101 N G2005002004only in a medicare-approved cmmi model. (services must be furnished within a G2005003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2005004004facility within 90 days following discharge from an inpatient facility and no G2005005004more than 9 times.) G2006001003Brief (20 minutes) in-home visit for an existing patient post-discharge. for Post-d/c h vst ext pt 20 m 13 A C M4A 1 02019010120190101 N G2006002004use only in a medicare-approved cmmi model. (services must be furnished within G2006003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2006004004facility within 90 days following discharge from an inpatient facility and no G2006005004more than 9 times.) G2007001003Limited (30 minutes) in-home visit for an existing patient post-discharge. for Post-d/c h vst ext pt 30 m 13 A C M4A 1 02019010120190101 N G2007002004use only in a medicare-approved cmmi model. (services must be furnished within G2007003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2007004004facility within 90 days following discharge from an inpatient facility and no G2007005004more than 9 times.) G2008001003Moderate (45 minutes) in-home visit for an existing patient post-discharge. for Post-d/c h vst ext pt 45 m 13 A C M4A 1 02019010120190101 N G2008002004use only in a medicare-approved cmmi model. (services must be furnished within G2008003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2008004004facility within 90 days following discharge from an inpatient facility and no G2008005004more than 9 times.) G2009001003Comprehensive (60 minutes) in-home visit for an existing patient Post-d/c h vst ext pt 60 m 13 A C M4A 1 02019010120190101 N G2009002004post-discharge. for use only in a medicare-approved cmmi model. (services must G2009003004be furnished within a beneficiary's home, domiciliary, rest home, assisted G2009004004living and/or nursing facility within 90 days following discharge from an G2009005004inpatient facility and no more than 9 times.) G2010001003Remote evaluation of recorded video and/or images submitted by an established Remot image submit by pt 13 A C M5D 1 02019010120190101 N 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 N 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 N 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 G2013001003Extensive (75 minutes) in-home visit for an existing patient post-discharge. Post-d/c h vst ext pt 75 m 13 A C M4A 1 02019010120190101 N G2013002004for use only in a medicare-approved cmmi model. (services must be furnished G2013003004within a beneficiary's home, domiciliary, rest home, assisted living and/or G2013004004nursing facility within 90 days following discharge from an inpatient facility G2013005004and no more than 9 times.) G2014001003Limited (30 minutes) care plan oversight. for use only in a medicare-approved Post-d/c care plan overs 30m13 A C M4A 1 02019010120190101 N G2014002004cmmi model. (services must be furnished within a beneficiary's home, G2014003004domiciliary, rest home, assisted living and/or nursing facility within 90 days G2014004004following discharge from an inpatient facility and no more than 9 times.) G2015001003Comprehensive (60 mins) home care plan oversight. for use only in a Post-d/c care plan overs 60m13 A C M4A 1 02019010120190101 N G2015002004medicare-approved cmmi model. (services must be furnished within a G2015003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing G2015004004facility within 90 days following discharge from an inpatient facility.) G2021001003Health care practitioners rendering treatment in place (tip) Hea care pract tx in place 00 9 C M5D 9 02020010120200101 A G2022001003A model participant (ambulance supplier/provider), the beneficiary refuses Benef refuses service, mod 00 9 C M5D 9 02020010120200101 A G2022002004services covered under the model (transport to an alternate G2022003004destination/treatment in place) G2058001003Chronic care management services, each additional 20 minutes of clinical staff Ccm add 20min 13 A C M5D 1 02020010120200101 A G2058002004time directed by a physician or other qualified health care professional, per G2058003004calendar month (list separately in addition to code for primary procedure). (do G2058004004not report g2058 for care management services of less than 20 minutes G2058005004additional to the first 20 minutes of chronic care management services during a G2058006004calendar month). (use g2058 in conjunction with 99490). (do not report 99490, G2058007004g2058 in the same calendar month as 99487, 99489, 99491)). G2061001003Qualified nonphysician healthcare professional online assessment, for an Qual nonmd est pt 5-10m 13 A C M5D 1 02020010120200101 A G2061002004established patient, for up to seven days, cumulative time during the 7 days; G20610030045-10 minutes G2062001003Qualified nonphysician healthcare professional online assessment service, for Qual nonmd est pt 11-20m 13 A C M5D 1 02020010120200101 A G2062002004an established patient, for up to seven days, cumulative time during the 7 G2062003004days; 11-20 minutes G2063001003Qualified nonphysician qualified healthcare professional assessment service, Qual nonmd est pt 21>min 13 A C M5D 1 02020010120200101 A G2063002004for an established patient, for up to seven days, cumulative time during the 7 G2063003004days; 21 or more minutes G2064001003Comprehensive care management services for a single high-risk disease, e.g., Md mang high risk dx 30 13 A C M5D 1 02020010120200101 A G2064002004principal care management, at least 30 minutes of physician or other qualified G2064003004health care professional time per calendar month with the following elements: G2064004004one complex chronic condition lasting at least 3 months, which is the focus G2064005004of the care plan, the condition is of sufficient severity to place patient at G2064006004risk of hospitalization or have been the cause of a recent hospitalization, the G2064007004condition requires development or revision of disease-specific care plan, the G2064008004condition requires frequent adjustments in the medication regimen, and/or the G2064009004management of the condition is unusually complex due to comorbidities G2065001003Comprehensive care management for a single high-risk disease services, e.g. Clin mang h risk dx 30 13 A C M5D 1 02020010120200101 A G2065002004principal care management, at least 30 minutes of clinical staff time directed G2065003004by a physician or other qualified health care professional, per calendar month G2065004004with the following elements: one complex chronic condition lasting at least 3 G2065005004months, which is the focus of the care plan, the condition is of sufficient G2065006004severity to place patient at risk of hospitalization or have been cause of a G2065007004recent hospitalization, the condition requires development or revision of G2065008004disease-specific care plan, the condition requires frequent adjustments in the G2065009004medication regimen, and/or the management of the condition is unusually complex G2065010004due to comorbidities G2066001003Interrogation device evaluation(s), (remote) up to 30 days; implantable Inter devc remote 30d 13 A C M5D 1 02020010120200101 A G2066002004cardiovascular physiologic monitor system, implantable loop recorder system, or G2066003004subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt G2066004004of transmissions and technician review, technical support and distribution of G2066005004results G2067001003Medication assisted treatment, methadone; weekly bundle including dispensing Med assist tx meth wk 13 A C M5D 1 02020010120200101 A G2067002004and/or administration, substance use counseling, individual and group therapy, G2067003004and toxicology testing, if performed (provision of the services by a G2067004004medicare-enrolled opioid treatment program) G2068001003Medication assisted treatment, buprenorphine (oral); weekly bundle including Med assist tx bupre oral 13 A C M5D 1 02020010120200101 A G2068002004dispensing and/or administration, substance use counseling, individual and G2068003004group therapy, and toxicology testing if performed (provision of the services G2068004004by a medicare-enrolled opioid treatment program) G2069001003Medication assisted treatment, buprenorphine (injectable); weekly bundle Med assist tx inject 13 A C M5D 1 02020010120200101 A G2069002004including dispensing and/or administration, substance use counseling, G2069003004individual and group therapy, and toxicology testing if performed (provision of G2069004004the services by a medicare-enrolled opioid treatment program) G2070001003Medication assisted treatment, buprenorphine (implant insertion); weekly bundle Med assist tx implant 13 A C M5D 1 02020010120200101 A G2070002004including dispensing and/or administration, substance use counseling, G2070003004individual and group therapy, and toxicology testing if performed (provision of G2070004004the services by a medicare-enrolled opioid treatment program) G2071001003Medication assisted treatment, buprenorphine (implant removal); weekly bundle Med tx remove implant 13 A C M5D 1 02020010120200101 A G2071002004including dispensing and/or administration, substance use counseling, G2071003004individual and group therapy, and toxicology testing if performed (provision of G2071004004the services by a medicare-enrolled opioid treatment program) G2072001003Medication assisted treatment, buprenorphine (implant insertion and removal); Med tx insert/remove imp 13 A C M5D 1 02020010120200101 A G2072002004weekly bundle including dispensing and/or administration, substance use G2072003004counseling, individual and group therapy, and toxicology testing if performed G2072004004(provision of the services by a medicare-enrolled opioid treatment program) G2073001003Medication assisted treatment, naltrexone; weekly bundle including dispensing Med tx naltrexone 13 A C M5D 1 02020010120200101 A G2073002004and/or administration, substance use counseling, individual and group therapy, G2073003004and toxicology testing if performed (provision of the services by a G2073004004medicare-enrolled opioid treatment program) G2074001003Medication assisted treatment, weekly bundle not including the drug, including Med assist tx no drug 13 A C M5D 1 02020010120200101 A G2074002004substance use counseling, individual and group therapy, and toxicology testing G2074003004if performed (provision of the services by a medicare-enrolled opioid treatment G2074004004program) G2075001003Medication assisted treatment, medication not otherwise specified; weekly Med tx meds nos 13 A C M5D 1 02020010120200101 A G2075002004bundle including dispensing and/or administration, substance use counseling, G2075003004individual and group therapy, and toxicology testing, if performed (provision G2075004004of the services by a medicare-enrolled opioid treatment program) G2076001003Intake activities, including initial medical examination that is a complete, Intake act w/med exam 13 A C M5D 1 02020010120200101 A G2076002004fully documented physical evaluation and initial assessment by a program G2076003004physician or a primary care physician, or an authorized healthcare professional G2076004004under the supervision of a program physician qualified personnel that includes G2076005004preparation of a treatment plan that includes the patient's short-term goals G2076006004and the tasks the patient must perform to complete the short-term goals; the G2076007004patient's requirements for education, vocational rehabilitation, and G2076008004employment; and the medical, psycho- social, economic, legal, or other G2076009004supportive services that a patient needs, conducted by qualified personnel G2076010004(provision of the services by a medicare-enrolled opioid treatment program); G2076011004list separately in addition to code for primary procedure G2077001003Periodic assessment; assessing periodically by qualified personnel to determine Periodic assessment 13 A C M5D 1 02020010120200101 A G2077002004the most appropriate combination of services and treatment (provision of the G2077003004services by a medicare-enrolled opioid treatment program); list separately in G2077004004addition to code for primary procedure G2078001003Take-home supply of methadone; up to 7 additional day supply (provision of the Take-home meth 13 A C M5D 1 02020010120200101 A G2078002004services by a medicare-enrolled opioid treatment program); list separately in G2078003004addition to code for primary procedure G2079001003Take-home supply of buprenorphine (oral); up to 7 additional day supply Take-hom buprenorphine 13 A C M5D 1 02020010120200101 A G2079002004(provision of the services by a medicare-enrolled opioid treatment program); G2079003004list separately in addition to code for primary procedure G2080001003Each additional 30 minutes of counseling in a week of medication assisted Add 30 mins counsel 13 A C M5D 1 02020010120200101 A G2080002004treatment, (provision of the services by a medicare-enrolled opioid treatment G2080003004program); list separately in addition to code for primary procedure G2081001003Patients age 66 and older in institutional special needs plans (snp) or Pt 66+ snp or ltc pos > 90d 00 9 C Z2 1 02020010120200101 A G2081002004residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than G208100300490 days during the measurement period G2082001003Office or other outpatient visit for the evaluation and management of an Visit esketamine 56m or less13 A C M1B 1 02020010120200101 A G2082002004established patient that requires the supervision of a physician or other G2082003004qualified health care professional and provision of up to 56 mg of esketamine G2082004004nasal self-administration, includes 2 hours post-administration observation G2083001003Office or other outpatient visit for the evaluation and management of an Visit esketamine, > 56m 13 A C M1B 1 02020010120200101 A G2083002004established patient that requires the supervision of a physician or other G2083003004qualified health care professional and provision of greater than 56 mg G2083004004esketamine nasal self-administration, includes 2 hours post-administration G2083005004observation G2086001003Office-based treatment for opioid use disorder, including development of the Off base opioid tx 70min 13 A C M5D 1 02020010120200101 A G2086002004treatment plan, care coordination, individual therapy and group therapy and G2086003004counseling; at least 70 minutes in the first calendar month G2087001003Office-based treatment for opioid use disorder, including care coordination, Off base opioid tx, 60 m 13 A C M5D 1 02020010120200101 A G2087002004individual therapy and group therapy and counseling; at least 60 minutes in a G2087003004subsequent calendar month G2088001003Office-based treatment for opioid use disorder, including care coordination, Off base opioid tx, add30 13 A C M5D 1 02020010120200101 A G2088002004individual therapy and group therapy and counseling; each additional 30 minutes G2088003004beyond the first 120 minutes (list separately in addition to code for primary G2088004004procedure) G2089001003Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0% A1c level 7 to 9% 00 9 C Z2 1 02020010120200101 A G2090001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and med dem 00 9 C Z2 1 02020010120200101 A G2090002004frailty during the measurement period and a dispensed medication for dementia G2090003004during the measurement period or the year prior to the measurement period G2091001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and adv ill 00 9 C Z2 1 02020010120200101 A G2091002004frailty during the measurement period and either one acute inpatient encounter G2091003004with a diagnosis of advanced illness or two outpatient, observation, ed or G2091004004nonacute inpatient encounters on different dates of service with an advanced G2091005004illness diagnosis during the measurement period or the year prior to the G2091006004measurement period G2092001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker Ace arb arni 00 9 C Z2 1 02020010120200101 A G2092002004(arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or G2092003004currently being taken G2093001003Documentation of medical reason(s) for not prescribing ace inhibitor or arb or Med doc rsn no ace arn arni 00 9 C Z2 1 02020010120200101 A G2093002004arni therapy (e.g., hypotensive patients who are at immediate risk of G2093003004cardiogenic shock, hospitalized patients who have experienced marked azotemia, G2093004004allergy, intolerance, other medical reasons) G2094001003Documentation of patient reason(s) for not prescribing ace inhibitor or arb or Pt rsn no ace arn arni 00 9 C Z2 1 02020010120200101 A G2094002004arni therapy (e.g., patient declined, other patient reasons) G2095001003Documentation of system reason(s) for not prescribing ace inhibitor or arb or Sys rsn no ace arn arni 00 9 C Z2 1 02020010120200101 A G2095002004arni therapy (e.g., other system reasons) G2096001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker No rsn ace arb arni 00 9 C Z2 1 02020010120200101 A G2096002004(arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not G2096003004prescribed, reason not given G2097001003Children with a competing diagnosis for upper respiratory infection within Child dx uri 3d of other dx 00 9 C Z2 1 02020010120200101 A G2097002004three days of diagnosis of pharyngitis (e.g., intestinal infection, pertussis, G2097003004bacterial infection, lyme disease, otitis media, acute sinusitis, acute G2097004004pharyngitis, acute tonsillitis, chronic sinusitis, infection of the G2097005004pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone G2097006004infections, acute lymphadenitis, impetigo, skin staph infections, G2097007004pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, G2097008004inflammatory diseases [female reproductive organs]), infections of the kidney, G2097009004cystitis or uti G2098001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and med dem 00 9 C Z2 1 02020010120200101 A G2098002004frailty during the measurement period and a dispensed medication for dementia G2098003004during the measurement period or the year prior to the measurement period G2099001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and adv ill 00 9 C Z2 1 02020010120200101 A G2099002004frailty during the measurement period and either one acute inpatient encounter G2099003004with a diagnosis of advanced illness or two outpatient, observation, ed or G2099004004nonacute inpatient encounters on different dates of service with an advanced G2099005004illness diagnosis during the measurement period or the year prior to the G2099006004measurement period G2100001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and med dem 00 9 C Z2 1 02020010120200101 A G2100002004frailty during the measurement period and a dispensed medication for dementia G2100003004during the measurement period or the year prior to the measurement period G2101001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and adv ill 00 9 C Z2 1 02020010120200101 A G2101002004frailty during the measurement period and either one acute inpatient encounter G2101003004with a diagnosis of advanced illness or two outpatient, observation, ed or G2101004004nonacute inpatient encounters on different dates of service with an advanced G2101005004illness diagnosis during the measurement period or the year prior to the G2101006004measurement period G2102001003Dilated retinal eye exam with interpretation by an ophthalmologist or Dil retinal eye exam 00 9 C Z2 1 02020010120200101 A G2102002004optometrist documented and reviewed G2103001003Seven standard field stereoscopic photos with interpretation by an 7 stereo photos interpret 00 9 C Z2 1 02020010120200101 A G2103002004ophthalmologist or optometrist documented and reviewed G2104001003Eye imaging validated to match diagnosis from seven standard field stereoscopic Eye img valid w/7 stereo 00 9 C Z2 1 02020010120200101 A G2104002004photos results documented and reviewed G2105001003Patients age 66 or older in institutional special needs plans (snp) or residing Pt 66+ lt ints > 90 00 9 C Z2 1 02020010120200101 A G2105002004in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days G2105003004during the measurement period G2106001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ lt ints > 90 00 9 C Z2 1 02020010120200101 A G2106002004frailty during the measurement period and a dispensed medication for dementia G2106003004during the measurement period or the year prior to the measurement period G2107001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and adv ill 00 9 C Z2 1 02020010120200101 A G2107002004frailty during the measurement period and either one acute inpatient encounter G2107003004with a diagnosis of advanced illness or two outpatient, observation, ed or G2107004004nonacute inpatient encounters on different dates of service with an advanced G2107005004illness diagnosis during the measurement period or the year prior to the G2107006004measurement period G2108001003Patients age 66 or older in institutional special needs plans (snp) or residing Pt 66+ lt ints > 90 00 9 C Z2 1 02020010120200101 A G2108002004in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days G2108003004during the measurement period G2109001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and med dem 00 9 C Z2 1 02020010120200101 A G2109002004frailty during the measurement period and a dispensed medication for dementia G2109003004during the measurement period or the year prior to the measurement period G2110001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and adv ill 00 9 C Z2 1 02020010120200101 A G2110002004frailty during the measurement period and either one acute inpatient encounter G2110003004with a diagnosis of advanced illness or two outpatient, observation, ed or G2110004004nonacute inpatient encounters on different dates of service with an advanced G2110005004illness diagnosis during the measurement period or the year prior to the G2110006004measurement period G2112001003Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is Pred<=5 mg ra glu <6m 00 9 C Z2 1 02020010120200101 A G2112002004worsening, or glucocorticoid use is for less than 6 months G2113001003Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 Pred>5 mg >6m, no chg da 00 9 C Z2 1 02020010120200101 A G2113002004months, and improvement or no change in disease activity G2114001003Patients 66-80 years of age with at least one claim/encounter for frailty Pt 66-80 frailty and med dem00 9 C Z2 1 02020010120200101 A G2114002004during the measurement period and a dispensed medication for dementia during G2114003004the measurement period or the year prior to the measurement period G2115001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and med dem 00 9 C Z2 1 02020010120200101 A G2115002004frailty during the measurement period and a dispensed medication for dementia G2115003004during the measurement period or the year prior to the measurement period G2116001003Patients 66 years of age and older with at least one claim/encounter for Pt 66+ frailty and adv ill 00 9 C Z2 1 02020010120200101 A G2116002004frailty during the measurement period and either one acute inpatient encounter G2116003004with a diagnosis of advanced illness or two outpatient, observation, ed or G2116004004nonacute inpatient encounters on different dates of service with an advanced G2116005004illness diagnosis during the measurement period or the year prior to the G2116006004measurement period G2117001003Patients 66-80 years of age with at least one claim/encounter for frailty Pt 66-80 frailty and adv ill00 9 C Z2 1 02020010120200101 A G2117002004during the measurement period and either one acute inpatient encounter with a G2117003004diagnosis of advanced illness or two outpatient, observation, ed or nonacute G2117004004inpatient encounters on different dates of service with an advanced illness G2117005004diagnosis during the measurement period or the year prior to the measurement G2117006004period G2118001003Patients 81 years of age and older with a evidence of frailty during the Pt 81+ frailty 00 9 C Z2 1 02020010120200101 A G2118002004measurement period G2119001003Within the past 2 years, calcium and/or vitamin d optimization has been ordered Calc vitd opt 00 9 C Z2 1 02020010120200101 A G2119002004or performed G2120001003Within the past 2 years, calcium and/or vitamin d optimization has not been No calc vitd opt 00 9 C Z2 1 02020010120200101 A G2120002004ordered or performed G2121001003Psychosis, depression, anxiety, apathy, and impulse control disorder assessed Psy dep anx ap and icd asse 00 9 C Z2 1 02020010120200101 A G2122001003Psychosis, depression, anxiety, apathy, and impulse control disorder not Psy/dep/anx/apandicd noasse 00 9 C Z2 1 02020010120200101 A G2122002004assessed G2123001003Patients 66-80 years of age and had at least one claim/encounter for frailty Pt 66-80 frailty med dem 00 9 C Z2 1 02020010120200101 A G2123002004during the measurement period and either one acute inpatient encounter with a G2123003004diagnosis of advanced illness or two outpatient, observation, ed or nonacute G2123004004inpatient encounters on different dates of service with an advanced illness G2123005004diagnosis during the measurement period or the year prior to the measurement G2123006004period G2124001003Patients 66-80 years of age and had at least one claim/encounter for frailty Pt 66-80 frailty adv ill 00 9 C Z2 1 02020010120200101 A G2124002004during the measurement period and a dispensed dementia medication G2125001003Patients 81 years of age and older with evidence of frailty during the Pt 81+ frailty 00 9 C Z2 1 02020010120200101 A G2125002004measurement period G2126001003Patients 66 years of age or older and had at least one claim/encounter for Pt 66+ frailty adv ill 00 9 C Z2 1 02020010120200101 A G2126002004frailty during the measurement period and either one acute inpatient encounter G2126003004with a diagnosis of advanced illness or two outpatient, observation, ed or G2126004004nonacute inpatient encounters on different dates of service with an advanced G2126005004illness diagnosis during the measurement period or the year prior to the G2126006004measurement period G2127001003Patients 66 years of age or older and had at least one claim/encounter for Pt 66+ frailty med dem 00 9 C Z2 1 02020010120200101 A G2127002004frailty during the measurement period and a dispensed dementia medication G2128001003Documentation of medical reason(s) for not on a daily aspirin or other No aspirin med rsn 00 9 C Z2 1 02020010120200101 A G2128002004antiplatelet (e.g. history of gastrointestinal bleed, intra-cranial bleed, G2128003004blood disorders, idiopathic thrombocytopenic purpura (itp), gastric bypass or G2128004004documentation of active anticoagulant use during the measurement period) G2129001003Procedure-related bp's not taken during an outpatient visit. examples include No bp outpt 00 9 C Z2 1 02020010120200101 A G2129002004same day surgery, ambulatory service center, g.i. lab, dialysis, infusion G2129003004center, chemotherapy G2130001003Patients age 66 or older in institutional special needs plans (snp) or residing Pt 66+ lt inst > 90 00 9 C Z2 1 02020010120200101 A G2130002004in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days G2130003004during the measurement period G2131001003Patients 81 years and older with a diagnosis of frailty Pt 81+ frailty 00 9 C Z2 1 02020010120200101 A G2132001003Patients 66-80 years of age with at least one claim/encounter for frailty Pt 66-80 frailty and med dem00 9 C Z2 1 02020010120200101 A G2132002004during the measurement period and a dispensed medication for dementia during G2132003004the measurement period or the year prior to the measurement period G2133001003Patients 66-80 years of age with at least one claim/encounter for frailty Pt 66-80 frailty and adv ill00 9 C Z2 1 02020010120200101 A G2133002004during the measurement period and either one acute inpatient encounter with a G2133003004diagnosis of advanced illness or two outpatient, observation, ed or nonacute G2133004004inpatient encounters on different dates of service with an advanced illness G2133005004diagnosis during the measurement period or the year prior to the measurement G2133006004period G2134001003Patients 66 years of age or older with at least one claim/encounter for frailty Pt 66+ frailty and med dem 00 9 C Z2 1 02020010120200101 A G2134002004during the measurement period and a dispensed medication for dementia during G2134003004the measurement period or the year prior to the measurement period G2135001003Patients 66 years of age or older with at least one claim/encounter for frailty Pt 66+ frailty and adv ill 00 9 C Z2 1 02020010120200101 A G2135002004during the measurement period and either one acute inpatient encounter with a G2135003004diagnosis of advanced illness or two outpatient, observation, ed or nonacute G2135004004inpatient encounters on different dates of service with an advanced illness G2135005004diagnosis during the measurement period or the year prior to the measurement G2135006004period G2136001003Back pain measured by the visual analog scale (vas) at three months (6 ? 20 Bk pain vas 6-20wk = 3 00 9 C Z2 1 02020010120200101 A G2136002004weeks) postoperatively was less than or equal to 3.0 or back pain measured by G2136003004the visual analog scale (vas) within three months preoperatively and at three G2136004004months (6 ? 20 weeks) postoperatively demonstrated an improvement of 5.0 points G2136005004or greater G2137001003Back pain measured by the visual analog scale (vas) at three months (6 ? 20 Bk pain vas 6-20wk > 3 00 9 C Z2 1 02020010120200101 A G2137002004weeks) postoperatively was greater than 3.0 and back pain measured by the G2137003004visual analog scale (vas) within three months preoperatively and at three G2137004004months (6 ? 20 weeks) postoperatively demonstrated a change of less than an G2137005004improvement of 5.0 points G2138001003Back pain as measured by the visual analog scale (vas) at one year (9 to 15 Bk pain vas 9-15mo = 3 00 9 C Z2 1 02020010120200101 A G2138002004months) postoperatively was less than or equal to 3.0 or back pain measured by G2138003004the visual analog scale (vas) within three months preoperatively and at one G2138004004year (9 to 15 months) postoperatively demonstrated a change of 5.0 points or G2138005004greater G2139001003Back pain measured by the visual analog scale (vas) pain at one year (9 to 15 Bk pain vas 9-20mo > 3 00 9 C Z2 1 02020010120200101 A G2139002004months) postoperatively was greater than 3.0 and back pain measured by the G2139003004visual analog scale (vas) within three months preoperatively and at one year (9 G2139004004to 15 months) postoperatively demonstrated a change of less than 5.0 G2140001003Leg pain measured by the visual analog scale (vas) at three months (6 ? 20 Leg pain vas 6-20wk = 3 00 9 C Z2 1 02020010120200101 A G2140002004weeks) postoperatively was less than or equal to 3.0 or leg pain measured by G2140003004the visual analog scale (vas) within three months preoperatively and at three G2140004004months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points G2140005004or greater G2141001003Leg pain measured by the visual analog scale (vas) at three months (6 ? 20 Leg pain vas 6-20wk > 3 00 9 C Z2 1 02020010120200101 A G2141002004weeks) postoperatively was greater than 3.0 and leg pain measured by the visual G2141003004analog scale (vas) within three months preoperatively and at three months (6 - G214100400420 weeks) postoperatively demonstrated less than an improvement of 5.0 points G2142001003Functional status measured by the oswestry disability index (odi version 2.1a) Fs odi 9-15mo postop<= 22 00 9 C Z2 1 02020010120200101 A G2142002004at one year (9 to 15 months) postoperatively was less than or equal to 22 or G2142003004functional status measured by the odi version 2.1a within three months G2142004004preoperatively and at one year (9 to 15 months) postoperatively demonstrated a G2142005004change of 30 points or greater G2143001003Functional status measured by the oswestry disability index (odi version 2.1a) Fs odi 9-15mo > 22 00 9 C Z2 1 02020010120200101 A G2143002004at one year (9 to 15 months) postoperatively was greater than 22 and functional G2143003004status measured by the odi version 2.1a within three months preoperatively and G2143004004at one year (9 to 15 months) postoperatively demonstrated a change of less than G214300500430 points G2144001003Functional status measured by the oswestry disability index (odi version 2.1a) Fs odi 6-20wk postop > 22 00 9 C Z2 1 02020010120200101 A G2144002004at three months (6 ? 20 weeks) postoperatively was less than or equal to 22 or G2144003004functional status measured by the odi version 2.1a within three months G2144004004preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated G2144005004a change of 30 points or greater G2145001003Functional status measured by the oswestry disability index (odi version 2.1a) Fsodi 6-20wk >22 or chg 30pt00 9 C Z2 1 02020010120200101 A G2145002004at three months (6 ? 20 weeks) postoperatively was greater than 22 and G2145003004functional status measured by the odi version 2.1a within three months G2145004004preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated G2145005004a change of less than 30 points G2146001003Leg pain as measured by the visual analog scale (vas) at one year (9 to 15 Leg pain vas 9-15mo <= 3 00 9 C Z2 1 02020010120200101 A G2146002004months) postoperatively was less than or equal to 3.0 or leg pain measured by G2146003004the visual analog scale (vas) within three months preoperatively and at one G2146004004year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points G2146005004or greater G2147001003Leg pain measured by the visual analog scale (vas) at one year (9 to 15 months) Leg pain vas 9-15mo > 3 00 9 C Z2 1 02020010120200101 A G2147002004postoperatively was greater than 3.0 and leg pain measured by the visual analog G2147003004scale (vas) within three months preoperatively and at one year (9 to 15 months) G2147004004postoperatively demonstrated less than an improvement of 5.0 points G2148001003Performance met: multimodal pain management was used Mpm used 00 9 C Z2 1 02020010120200101 A G2149001003Documentation of medical reason(s) for not using multimodal pain management No mpm med rsn 00 9 C Z2 1 02020010120200101 A G2149002004(e.g., allergy to multiple classes of analgesics, intubated patient, hepatic G2149003004failure, patient reports no pain during pacu stay, other medical reason(s)) G2150001003Performance not met: multimodal pain management was not used No mpm 00 9 C Z2 1 02020010120200101 A G2151001003Patients with diagnosis of a degenerative neurological condition such as als, Dx degen neuro 00 9 C Z2 1 02020010120200101 A G2151002004ms, parkinson's diagnosed at any time before or during the episode of care G2152001003Performance met: the residual change score is equal to or greater than 0 Res change sc =0 00 9 C Z2 1 02020010120200101 A G2153001003In hospice or using hospice services during the measurement period Hosp dur meas pd 00 9 C Z2 1 02020010120200101 A G2154001003Patient received at least one td vaccine or one tdap vaccine between nine years Td 9 yrs start end meas 00 9 C Z2 1 02020010120200101 A G2154002004prior to the start of the measurement period and the end of the measurement G2154003004period G2155001003Patient had history of at least one of the following contraindications any time Hist contraindications 00 9 C Z2 1 02020010120200101 A G2155002004during or before the measurement period: anaphylaxis due to tdap vaccine, G2155003004anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or G2155004004td vaccination (post tetanus vaccination encephalitis, post diphtheria G2155005004vaccination encephalitis or post pertussis vaccination encephalitis.) G2156001003Patient did not receive at least one td vaccine or one tdap vaccine between No prior td or hx contra 00 9 C Z2 1 02020010120200101 A G2156002004nine years prior to the start of the measurement period and the end of the G2156003004measurement period; or have history of at least one of the following G2156004004contraindications any time during or before the measurement period: anaphylaxis G2156005004due to tdap vaccine, anaphylaxis due to td vaccine or its components; G2156006004encephalopathy due to tdap or td vaccination (post tetanus vaccination G2156007004encephalitis, post diphtheria vaccination encephalitis or post pertussis G2156008004vaccination encephalitis.) G2157001003Patients received both the 13-valent pneumococcal conjugate vaccine and the Pneum vacc 12 mo 60+ 00 9 C Z2 1 02020010120200101 A G215700200423-valent pneumococcal polysaccharide vaccine at least 12 months apart, with G2157003004the first occurrence after the age of 60 before or during the measurement period G2158001003Patient had prior pneumococcal vaccine adverse reaction any time during or Pneum vacc adv rx 00 9 C Z2 1 02020010120200101 A G2158002004before the measurement period G2159001003Patient did not receive both the 13-valent pneumococcal conjugate vaccine and No pneum vacc 12 mo 60+ 00 9 C Z2 1 02020010120200101 A G2159002004the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, G2159003004with the first occurrence after the age of 60 before or during measurement G2159004004period; or have prior pneumococcal vaccine adverse reaction any time during or G2159005004before the measurement period G2160001003Patient received at least one dose of the herpes zoster live vaccine or two Herpzos 50+ 00 9 C Z2 1 02020010120200101 A G2160002004doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime G2160003004on or after the patient's 50th birthday before or during the measurement period G2161001003Patient had prior adverse reaction caused by zoster vaccine or its components Adv rx zos 00 9 C Z2 1 02020010120200101 A G2161002004any time during or before the measurement period G2162001003Patient did not receive at least one dose of the herpes zoster live vaccine or No herpzos 50+ 00 9 C Z2 1 02020010120200101 A G2162002004two doses of the herpes zoster recombinant vaccine (at least 28 days apart) G2162003004anytime on or after the patient's 50th birthday before or during the G2162004004measurement period; or have prior adverse reaction caused by zoster vaccine or G2162005004its components any time during or before the measurement period G2163001003Patient received an influenza vaccine on or between july 1 of the year prior to Infl vacc 07/01 to 06/30 00 9 C Z2 1 02020010120200101 A G2163002004the measurement period and june 30 of the measurement period G2164001003Patient had a prior influenza virus vaccine adverse reaction any time before or Adv rx infl vacc 00 9 C Z2 1 02020010120200101 A G2164002004during the measurement period G2165001003Patient did not receive an influenza vaccine on or between july 1 of the year No infl vacc 07/01 to 06/30 00 9 C Z2 1 02020010120200101 A G2165002004prior to the measurement period and june 30 of the measurement period; or did G2165003004not have a prior influenza virus vaccine adverse reaction any time before or G2165004004during the measurement period G2166001003Patient refused to participate at admission and/or discharge; patient unable to No pt adm dx no neck fs prom00 9 C Z2 1 02020010120200101 A G2166002004complete the neck fs prom at admission or discharge due to cognitive deficit, G2166003004visual deficit, motor deficit, language barrier, or low reading level, and a G2166004004suitable proxy/recorder is not available; patient self-discharged early; G2166005004medical reason G2167001003Performance not met: the residual change score is less than 0 Res change sc < 0 00 9 C Z2 1 02020010120200101 A 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 N 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 N 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 0201101012020010120191231D G8649002004not measured because the patient did not complete the fs status survey near G8649003004discharge, patient not appropriate G8650001003Risk-adjusted functional status change residual score for the knee impairment Rafs crs ki no scor no surv 00 9 C M5B 1 02011010120200101 C G8650002004not measured because the patient did not complete the knee fs prom at initial G8650003004evaluation and/or 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 N 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 N 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 0201101012020010120191231D 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 Rafs crs hi no scor no surv 00 9 C M5B 1 02011010120200101 S 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 N 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 N 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 0201101012020010120191231D 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 N 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 N 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 N 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 N 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 Rafs crs lbi no scor no surv00 9 C M5B 1 02011010120200101 C G8662002004impairment not measured because the patient did not complete the low back fs G8662003004prom at initial evaluation and/or near discharge, reason not given G8663001003Risk-adjusted functional status change residual score for the shoulder Rafscrs si scor >= 0 00 9 C M5B 1 02011010120190101 N 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 N 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 0201101012020010120191231D 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 Rafs crs si no scor no surv 00 9 C M5B 1 02011010120200101 C G8666002004impairment not measured because the patient did not complete the shoulder fs G8666003004prom at initial evaluation and/or near discharge, reason not given G8667001003Risk-adjusted functional status change residual score for the elbow, wrist or Rafscrs ewh scor >= 0 00 9 C M5B 1 02011010120190101 N 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 N 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 0201101012020010120191231D 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 Rafs crs ewh no scor no surv00 9 C M5B 1 02011010120200101 C G8670002004hand impairment not measured because the patient did not complete the